Archive for September, 2020

Stop Loss Claim Nightmare

Wednesday, September 30th, 2020

Busy Jill – She Had 18 Children In Less Than 10 Years

Not too many plan sponsors have ever conducted health plan dependent eligibility audits leaving them at risk of stop loss claim denials. If Little Johnny is the covered employee’s nephew, with the same last name, has a stop loss claim you can rest assured the stop loss carrier will determine they are not at risk leaving the plan sponsor eating the entire claim……………A ticking time bomb waiting to happen…………….

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DART – Dallas Area Rapid Transit RFP for Pharmacy Benefits Consultant

Tuesday, September 29th, 2020

Dallas Area Rapid Transit is a transit agency serving the Dallas–Fort Worth metroplex of Texas. It operates buses, light rail, commuter rail, and high-occupancy vehicle lanes in Dallas and twelve of its suburbs. Wikipedia

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Small Business Stabilization Program by United Advantage

Monday, September 28th, 2020

First Financial Targets Texas School Districts

Monday, September 28th, 2020

“First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools.”

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Is Opopira on Your Rx Formulary?

Monday, September 28th, 2020

Twin brothers invented Opopira, considered a miracle drug back in the day, a pasty mass consisting of a drug mixed with sugar and water or honey suitable for oral administration. This complex compound drug was used to treat diverse maladies including paralysis. 

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$1 Tele-Health Visit

Sunday, September 27th, 2020

Sam’s Club and 98point6 are partnering to offer members $1 telehealth visits…..

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Imagine If There’s No PBMs – Its Easy If You Try

Sunday, September 27th, 2020

Once upon a time there was no such thing as a PBM…………………….

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Saturday, September 26th, 2020

“Healthcare is the only expense line item in which all employees receive an unlimited budget…and also no training in how to spend it. That’s why they sign up for $2500 procedures when a $75 solution would do the trick.”  – Dave Chase

“Hiding Cost of Healthcare an ‘Insult to Americans”

Saturday, September 26th, 2020

 “When the patient gets the bill, it looks like the insurer haggled on their behalf. Yet the final charge is still much higher than it should have been. The patient loses, while the insurer and provider win.” – Nikki Haley

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Free Rx

Saturday, September 26th, 2020

Trolling the internet on Chinese Flu quarantine day # 267 (and counting) we came across a website touting “Free Rx.” As we suspected, it was just another third party intermediary offering to assist consumers in applying for Rx manufacturer assistance programs. For a fee of course.

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Dan Crenshaw’s Band of Brothers & Sisters Pledge Healthcare Reforms

Friday, September 25th, 2020

Health Care:

We will fight for personalized, affordable health care that puts YOU in control, not a government takeover that puts a bureaucrat in control.

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TRS ActiveCare Enrollment / Financial Projections

Thursday, September 24th, 2020

What are the statistics for TRS plan year 2020-2021? How many employees have moved over to heretofore illegal, competing commercial health plans and away from the state sponsored TRS ActiveCare government plan? What is the financial impact?

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Supreme Court To Hear PPACA Challenge With or Without New Justice

Thursday, September 24th, 2020

Single payer system by 2028? Will Republicans embrace Obama Care as the better of two evils? Will whatever the Supreme Court decides have little effect on political realities?

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Charlie Meets The Tyler Rose & He’s Glad He Did………….

Wednesday, September 23rd, 2020

After talking with The Tyler (Grow Some Balls) Rose, Charlie was convinced he could achieve his goal of creating a better health plan — one his 150 employees deserved……………

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Dave Chase Announces Newest Book Release

Wednesday, September 23rd, 2020

I’ve been hard at work on something I’m very proud of: a roadmap for communities, large and small, to restore hope, health and well-being.

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Low Bid Gets The Business

Tuesday, September 22nd, 2020

Beginning an initial dialog with “How much will you charge us” is never a good indication things will go well with your chances of gaining a new client as long as pricing is the driving consideration.

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Whoa…………………..

Friday, September 18th, 2020

RAND stokes hospital pricing transparency fire with new report

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10 Most Common Procedures in ASCs

Friday, September 18th, 2020

Angie Stewart – Friday, January 10th, 2020

Eye and gastroenterology procedures are some of the most common services proliferated in ASCs, according to a March 2019 report by the Medicare Payment Advisory Commission.

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Emancipation Proclamation

Monday, September 14th, 2020

Freedom from high drug prices…………………………………..

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King Murray

Sunday, September 13th, 2020

Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!

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Ballot Box, Courtrooms & Smoke Filled Rooms

Sunday, September 13th, 2020

The future of healthcare will be decided via the ballot box, court rooms, and congressional halls.

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MGU Founded Aboard Love Boat

Sunday, September 13th, 2020

Love Boat Cruise Spawns MGU……………………………

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Another Austin Insurance Insurance Startup Raises $20,800,000

Sunday, September 13th, 2020

Austin Startup Sana Benefits Raises $20.8M to Provides Self-funded Health Insurance to Small Businesses

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Austin Insurance Startup Raises $10,000,000

Sunday, September 13th, 2020

Austin-based health insurance startup Decent has raised $10 million as it looks to expand statewide.

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Managing The Cost of Risk vs. Insurance Brokerage

Monday, September 7th, 2020

For Fairly, the real story – and challenge– is not about insurance markets; rather it is about risk management.

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Meet Bind – Health Insurance For Companies

Saturday, September 5th, 2020

With Bind, costs and choices are transparent and easy to compare. There is no deductible or coinsurance to meet before the plan starts contributing, and members can change and shape their coverage as their health needs change.

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Reduce Healthcare Costs by Offering a ‘Free’ Option

Saturday, September 5th, 2020

If you had a group of employees traveling on a business trip and you told them they’d only need to pay a $100 contribution toward the hotel room, what’s to stop them from choosing a Ritz Carlton over a Days Inn? Both provide a decent night’s sleep, but one will cost you, the employer, a significant amount more.

This is what manufacturing firms are doing now with their benefit plans

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Aetna Touts Cheap “I-35 Discount Providers”

Friday, September 4th, 2020

Our discounts are the best!” says a BUCA rep. “No, ours is!” responds a competitor.

“Holy Smoke guys, we’ve singled out our cheapest providers,  much cheaper than all the others,  20% cheaper! We call it the  I-35 Performance Network.” says the Aetna rep.

“That’s weird” says the RBP broker. “Why pay providers differently unless there is a difference?”

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The 50% Club

Thursday, September 3rd, 2020

“I Was Raised To Pay My Debts On Time…………..”

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…………….

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Protection Money Scheme Dominates HealthCare

Thursday, September 3rd, 2020

Pssst…Godfather, Mulebriar Is At It Again!

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The Fallacy of PPO Re-Pricing Exercise

Thursday, September 3rd, 2020

Each time I see a Request for Proposals put out by insurance consultants requiring a PPO Re-Pricing Exercise in an effort to determine which network has the best discounts the temptation to reach out to Jose Cuervo is tough to ignore. 

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GoodRx Files To Go Public

Wednesday, September 2nd, 2020

GoodRx’s profitability is a rarity among start-ups filing to go public……………..

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