Effective in 2021, employee benefit plan fiduciaries will be required to get fee disclosures from service providers…………..this means hidden fees earned by many brokers (especially the large national brokerages) must be disclosed to newly horrified plan sponsors

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Traditional PBM Representative Reacts 

In 2011 when the Employers’ Advanced Cooperative on Healthcare founded Employers’ ChoiceRx (ECRx) it was the first pharmacy BENEFIT solution built to be a transparent/cost-plus program that focused on “therapeutic equivalent” drugs to achieve a lowest net cost reference price.

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Approved cardholders receive immediate access a revolving credit line of up to $30,000 to pay for covered health care expenses……………….

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“The pharmacy benefit managers are not going to like what we are doing when it comes to ScriptCo.”

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Districts of Innovation offering competing health plans have impacted TRS membership this year. Market intelligence tells us one of the new competing health plans has captured approximately 12,000 employee lives with a total of 17,000 members………….

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Lone Ranger Rejoices – No More Mask!

Researchers from Tel Aviv University have proven that the Chinese Flu virus can be killed efficiently, quickly and cheaply using ultraviolet light-emitting diodes……..all in 30 seconds…………

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In-sur-ance (in-shoor’ens) n. 1.a. The act, business, or means of insuring persons or property. b. The state of being insured. 2. A contract binding a company to indemnify an insured party against specified loss. 3. The sum of which something is insured. 4. RiskManagers

Insure (in-shoor’) v. – sured, -suring. 1. To protect against loss, damage, etc. with insurance. 2.  Also ensure (en-). To insure n. RiskManagers

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Hospitals Hate Pricing Transparency

Hospitals failing to comply will be subject to a chump change fine not to exceed $300 per day ($109,500 per year). Plus the government will attempt to embarrass non-complying hospitals by posting notice of the penalty on the government’s CMS website for all the world to see and marvel……..

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Why would any provider want to be in-network if they know they will always get more than what a plan pays?

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Andrew Jackson – Champion of The Common Man

After years of being stymied by well-funded interests, Congress has agreed to ban one of the most costly and exasperating practices in medicine: surprise medical bills……………

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“Although not traditionally classed as self-insurance, program business involves an intermediary assuming many of the roles of an insurance company……….”

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We provide production underwriting services on behalf of Life & Health insurers and managed care organizations for new and renewal business.

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Senate Approves Repeal of Health Insurers’ Antitrust Exemption

By Allison Bell

The repeal bill, H.R. 1418, is now heading to the president’s desk. Read More

Late Monday, both Houses of Congress approved the Consolidated Appropriations Act, 2021 (“CAA”) providing for a sweeping $900 billion rescue package to deliver much-needed relief for small businesses.

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Professional liability, also known as Errors and Omissions Insurance (E&O), protects you if you’re sued for negligently performing services, even if you haven’t made a mistake. Coverage also includes defense costs associated with any lawsuit.

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Health care providers looking to seize opportunities to drive members to their network through their own self-funded products such as hospital owned Community Based Health Plans……………….

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Creates a complex arbitration process between insurers/ self-insured plans and medical providers…………Arbiters are prohibited from taking into account the provider’s “list price” billed charges……………..

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TRS ActiveCare used to be a great deal for teachers, but unfortunately that’s no longer the case. Alternative choices can provide a better solution for Texas teachers and their families.

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Prescription drug costs continue to escalate. Is it better to fully-insure or self-fund the risk?

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“All white people to the back of the bus” screams Harald……………………..

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Hey Doc, how much will you charge, cash, for a Carpal Tunnel Release?. If I like it I’ll pay you in full on the day of service……………………or before if you insist.

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Newest Chinese export benefits corporate coffers worldwide by lowering health care costs for plan sponsors……………….

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The service would bypass health-insurance plans and brokers and could help to lower the cost of healthcare.

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The Gift of Hardship by Tatiana Denning is an excellent short 5 minute read of “Our most important life lessons come when difficulties rain upon us.” 

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An online one-stop shop for small business owners looking for medical coverage for 2 employees up to 300. (more…)

The District (HOSPITAL) argues the insurance cards failed to adequately disclose that the patient’s ELAP plan contracts with MultiPlan only for physician services, not facility services.

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Please wait here in the examing room. Our lab technician will see you in just a few short minutes……

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The company will use the financing to expand its offerings into new markets and further scale its operations in response to growing demand……………..

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In 2013, he made $5 million. Three years earlier, he made $8 million. That’s the kind of money you might expect the CEO of one of the largest hospital chains in the country to earn.

But Ray Ingham isn’t the chief executive of a major health system………………

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TRS ActiveCare will not release claim experience for those districts who wish to offer a competitive commercial health plan alternative. Since experience rating is not possible in these cases, some other way must be employed to underwrite the risk.

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The value in the insurance offering comes from GM and OnStar’s ability to leverage the businesses’ already established ecosystems and improve customers’ insurance experiences. ………….

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Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell | December 10, 2020 at 04:59 PM

The justices held that Arkansas can set payment rules that affect ERISA plans’ pharmacy benefits managers.

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Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell

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Tenet projects the transaction will generate double-digit returns within three years of its completion and 42 percent of Tenet’s adjusted-EBITDA will be generated by USPI’s ambulatory business next year, up from 4 percent in 2014.

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“We strongly believe these losses are covered in full by our insurance policies, and are confident that the court and jury will agree.”

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Increasing litigation, broader definitions of liability, more plaintiff-friendly legal decisions, and larger compensatory jury awards………………….

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Fast & Easy Application for 180+ Professions – Business & Personal Lines

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An employer recently asked if there was any difference in the level of Medicare reimbursements for the two hospitals in their community.

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Doug Aldeen believes commercial insurance plans serve as an ATM for hospitals at the employers and patients expense………..

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Founded in 1986 and headquartered in Boston, Massachusetts, PCG helps primarily public sector health, education, and human services organizations make measurable improvements to their performance and processes.

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The plan offered a guarantee cost for three years – Fixed Cost, Claim Cost and Reserves…………..

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Teachers have historically complained about poor pay and terrible health benefits. Now many of them point to the life threatening environment of the classroom. “I can’t teach in a Death Chamber” is the message to school district officials and taxpayers. So parents remove their children from the public classroom leading to reduced tax revenues for education, continued crappy health benefits and less pay………….

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A September 21, 2011 email reminds us of how much Reference Based Pricing strategies has grown here in Texas. This email (a portion of which is shown below) is from RiskManagers.us to a client……..

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PNOA has mostly Medicare based reimbursements and has achieved aggressive discounts…………

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A recent study of a population with high health care utilization rates found giving individuals access to over-the-counter care benefits can reduce the number of avoidable ER visits and hospital admissions while improving member satisfaction and saving health plans millions of dollars.

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Being out-of-network has never been better! Let’s charge $10,000 for a test that costs $130 and never have to worry about not being paid the full amount………………………..

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