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
Month: December 2020
Employers Choice Rx Adopts RBP Approach
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.
SmartHealth PayCard
Approved cardholders receive immediate access a revolving credit line of up to $30,000 to pay for covered health care expenses……………….
Professor Aldine Updates SAT Test
Professor Doug Aldine updates SAT test question/s for wannabe college students hell bent on achieving little by way of a college degree…………….
Infections Disease Racial Disparities Task Force
Pitting Hyphenated Americans against each other using health care as a political tool to do so……………………
Continue reading Infections Disease Racial Disparities Task Force
Holy Cow!
TRS ActiveCare Update
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………….
Killing Chinese Flu Virus In 30 Seconds
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…………
P&C Brokerage
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
To Comply or Not To Comply, That Is The Question
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……..
Continue reading To Comply or Not To Comply, That Is The Question
Providers Find Silver Lining in “No Surprises Bill”
Why would any provider want to be in-network if they know they will always get more than what a plan pays?
Continue reading Providers Find Silver Lining in “No Surprises Bill”
Government Acts Against Money Interests – Sides With The Common Man
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……………
Continue reading Government Acts Against Money Interests – Sides With The Common Man
Oscar Health – San Antonio Market Rates
What Is Program Insurance?
“Although not traditionally classed as self-insurance, program business involves an intermediary assuming many of the roles of an insurance company……….”
Program Managers
We provide production underwriting services on behalf of Life & Health insurers and managed care organizations for new and renewal business.
Texas State Board of Pharmacy Has Outlawed Paper Prescriptions?
Continue reading Texas State Board of Pharmacy Has Outlawed Paper Prescriptions?
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
Printing Money That Has No Value
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.
Professional Liability Insurance
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.
Health Care Providers Eye Self-Funding Opportunities
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……………….
Continue reading Health Care Providers Eye Self-Funding Opportunities
Congress Releases Surprise Billing Compromise
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……………..
Continue reading Congress Releases Surprise Billing Compromise
Tom & Sally Vaccinated in 1801 Amidst Pandemic
The Biblical Alternative to TRS ActiveCare
https://youtu.be/87c4Ax89XL4
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.
Fully-Insured Prescription Drug Plans
Prescription drug costs continue to escalate. Is it better to fully-insure or self-fund the risk?
Chinese Flu Vacination Protocol Suggested By Health Policy Expert
“All white people to the back of the bus” screams Harald……………………..
Continue reading Chinese Flu Vacination Protocol Suggested By Health Policy Expert
Egregious Third Party Fees Gained At Provider’s Expense
“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Reference Based Pricing may not make much sense to those in the domino parlor.”
Continue reading Egregious Third Party Fees Gained At Provider’s Expense
Move Over BCBS, Aetna, UHC & The Rest – Lisa Gets The Best Prices, Yours Suck
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.
Continue reading Move Over BCBS, Aetna, UHC & The Rest – Lisa Gets The Best Prices, Yours Suck
Chinese Exports Help Reduce U.S. Health Care Costs
Newest Chinese export benefits corporate coffers worldwide by lowering health care costs for plan sponsors……………….
Continue reading Chinese Exports Help Reduce U.S. Health Care Costs
World’s Richest Man Bets His Money on Primary Care Strategies
The service would bypass health-insurance plans and brokers and could help to lower the cost of healthcare.
Continue reading World’s Richest Man Bets His Money on Primary Care Strategies
The Gift of Hardship
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.”
An Online One-Stop Shop For Small Business’s of 2-300 Employee Lives
An online one-stop shop for small business owners looking for medical coverage for 2 employees up to 300. Continue reading An Online One-Stop Shop For Small Business’s of 2-300 Employee Lives
Lawsuits & Class Action – It’s All In The Cards
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.
Continue reading Lawsuits & Class Action – It’s All In The Cards
Surprising New Chinese Flu Test Shows Promising Results
Please wait here in the examing room. Our lab technician will see you in just a few short minutes……
Continue reading Surprising New Chinese Flu Test Shows Promising Results
Centivo Raises $34 Million To Serve Self-Funded Employers
The company will use the financing to expand its offerings into new markets and further scale its operations in response to growing demand……………..
Continue reading Centivo Raises $34 Million To Serve Self-Funded Employers
Holy Cow Mamacita!
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………………
Underwriting TRS ActiveCare Alternative Commercial Health Plans
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.
Continue reading Underwriting TRS ActiveCare Alternative Commercial Health Plans
Oh Oh, The Tape Was Running………………………..
General Motors To Enter The Insurance Business
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. ………….
Continue reading General Motors To Enter The Insurance Business
Rutledge v. Pharmaceutical Care Management Association
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.
Continue reading Rutledge v. Pharmaceutical Care Management Association
Supreme Court Sides With States in Drug Benefits Ruling
$1.1B deal will give Tenet 45 SurgCenter ASCs
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.
Continue reading $1.1B deal will give Tenet 45 SurgCenter ASCs
Antidote for Contracts of Adhesion
Quizzify’s offering an elegant solution to fight surprise medical bills.
Download the solution now!
Major League Sues Insurers Over Chinese Flu Losses
“We strongly believe these losses are covered in full by our insurance policies, and are confident that the court and jury will agree.”
Continue reading Major League Sues Insurers Over Chinese Flu Losses
Social Inflation Hurting Insurance
Increasing litigation, broader definitions of liability, more plaintiff-friendly legal decisions, and larger compensatory jury awards………………….
Cover Your Ass Insurance
Fast & Easy Application for 180+ Professions – Business & Personal Lines
Hospital Shopping with Payer Compass RBP
An employer recently asked if there was any difference in the level of Medicare reimbursements for the two hospitals in their community.
Bulldog Attorney Warrior Opines on Health Care
Doug Aldeen believes commercial insurance plans serve as an ATM for hospitals at the employers and patients expense………..
Continue reading Bulldog Attorney Warrior Opines on Health Care
Ambulance Trips leave Door Open For High, Unexpected Bills
Continue reading Ambulance Trips leave Door Open For High, Unexpected Bills
Public Consulting Group – Valued Resource For Texas School Districts
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.
Continue reading Public Consulting Group – Valued Resource For Texas School Districts
What Ever Happened To The Texas Health Affiliate Plan?
The plan offered a guarantee cost for three years – Fixed Cost, Claim Cost and Reserves…………..
Continue reading What Ever Happened To The Texas Health Affiliate Plan?
Texas School Districts Facing Fiscal Disaster
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………….
Continue reading Texas School Districts Facing Fiscal Disaster
Traveling Down Memory Lane
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……..
Cover Your Ass Insurance
https://youtu.be/BCloP2DKtL0
Provider Network of America (PNOA)
PNOA has mostly Medicare based reimbursements and has achieved aggressive discounts…………
Study Shows OTC Program Reduced Hospital Admissions By 39%
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.
Continue reading Study Shows OTC Program Reduced Hospital Admissions By 39%
Physician Is Seriously Pissed
https://youtu.be/QiNoeUytIJI
Quote & Bind Liability Insurance Online
Government Mandates Listed Price Must Be Paid By Health Plans
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………………………..
Continue reading Government Mandates Listed Price Must Be Paid By Health Plans