Archive for December, 2020

Let The Sun Shine In………………..

Thursday, December 31st, 2020

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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Employers Choice Rx Adopts RBP Approach

Thursday, December 31st, 2020

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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SmartHealth PayCard

Thursday, December 31st, 2020

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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Professor Aldine Updates SAT Test

Wednesday, December 30th, 2020

Professor Doug Aldine updates SAT test question/s for wannabe college students hell bent on achieving little by way of a college degree…………….

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Infections Disease Racial Disparities Task Force

Wednesday, December 30th, 2020

Pitting Hyphenated Americans against each other using health care as a political tool to do so……………………

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Holy Cow!

Wednesday, December 30th, 2020
“The pharmacy benefit managers are not going to like what we are doing when it comes to ScriptCo.”

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TRS ActiveCare Update

Tuesday, December 29th, 2020

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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Killing Chinese Flu Virus In 30 Seconds

Monday, December 28th, 2020

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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P&C Brokerage

Monday, December 28th, 2020

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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To Comply or Not To Comply, That Is The Question

Monday, December 28th, 2020

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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Providers Find Silver Lining in “No Surprises Bill”

Sunday, December 27th, 2020

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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Government Acts Against Money Interests – Sides With The Common Man

Friday, December 25th, 2020

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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Oscar Health – San Antonio Market Rates

Thursday, December 24th, 2020
Under new ICHRA’s employers can pay the cost of individual health insurance plans like Oscar Health . See Oscar’s San Antonio area benefits and rates for 2021.

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What Is Program Insurance?

Wednesday, December 23rd, 2020

“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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Program Managers

Wednesday, December 23rd, 2020

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

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Texas State Board of Pharmacy Has Outlawed Paper Prescriptions?

Wednesday, December 23rd, 2020
    Darrel Pruit, DDS
Attention Texas dental patients. You should read this.

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Wednesday, December 23rd, 2020

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

Wednesday, December 23rd, 2020

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 Insurance

Monday, December 21st, 2020

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 Eye Self-Funding Opportunities

Sunday, December 20th, 2020

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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Congress Releases Surprise Billing Compromise

Sunday, December 20th, 2020

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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Tom & Sally Vaccinated in 1801 Amidst Pandemic

Sunday, December 20th, 2020

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The Biblical Alternative to TRS ActiveCare

Saturday, December 19th, 2020

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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Fully-Insured Prescription Drug Plans

Saturday, December 19th, 2020

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

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Chinese Flu Vacination Protocol Suggested By Health Policy Expert

Saturday, December 19th, 2020

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

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Egregious Third Party Fees Gained At Provider’s Expense

Friday, December 18th, 2020

domino

“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.”

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Move Over BCBS, Aetna, UHC & The Rest – Lisa Gets The Best Prices, Yours Suck

Thursday, December 17th, 2020

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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Chinese Exports Help Reduce U.S. Health Care Costs

Thursday, December 17th, 2020

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

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World’s Richest Man Bets His Money on Primary Care Strategies

Thursday, December 17th, 2020

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

Wednesday, December 16th, 2020

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’s of 2-300 Employee Lives

Wednesday, December 16th, 2020

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

Lawsuits & Class Action – It’s All In The Cards

Wednesday, December 16th, 2020

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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Tuesday, December 15th, 2020

Tuesday, December 15th, 2020

Surprising New Chinese Flu Test Shows Promising Results

Sunday, December 13th, 2020

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

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Centivo Raises $34 Million To Serve Self-Funded Employers

Sunday, December 13th, 2020

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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Holy Cow Mamacita!

Sunday, December 13th, 2020

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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Underwriting TRS ActiveCare Alternative Commercial Health Plans

Sunday, December 13th, 2020

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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Oh Oh, The Tape Was Running………………………..

Saturday, December 12th, 2020

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General Motors To Enter The Insurance Business

Friday, December 11th, 2020

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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Rutledge v. Pharmaceutical Care Management Association

Friday, December 11th, 2020

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

Thursday, December 10th, 2020

Supreme Court Sides With States in Drug Benefits Ruling

By Allison Bell

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$1.1B deal will give Tenet 45 SurgCenter ASCs

Thursday, December 10th, 2020

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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Antidote for Contracts of Adhesion

Thursday, December 10th, 2020

Quizzify’s offering an elegant solution to fight surprise medical bills.

Download the solution now!

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Major League Sues Insurers Over Chinese Flu Losses

Thursday, December 10th, 2020

“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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Social Inflation Hurting Insurance

Thursday, December 10th, 2020

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

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Cover Your Ass Insurance

Wednesday, December 9th, 2020

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

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Hospital Shopping with Payer Compass RBP

Wednesday, December 9th, 2020

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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Bulldog Attorney Warrior Opines on Health Care

Wednesday, December 9th, 2020

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

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Ambulance Trips leave Door Open For High, Unexpected Bills

Wednesday, December 9th, 2020
What are you supposed to do,” asked Pogue, the health policy analyst, “negotiate with the 9-1-1 operator?”

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Public Consulting Group – Valued Resource For Texas School Districts

Tuesday, December 8th, 2020

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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What Ever Happened To The Texas Health Affiliate Plan?

Monday, December 7th, 2020

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

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Texas School Districts Facing Fiscal Disaster

Monday, December 7th, 2020

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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Traveling Down Memory Lane

Sunday, December 6th, 2020

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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Cover Your Ass Insurance

Sunday, December 6th, 2020

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Provider Network of America (PNOA)

Sunday, December 6th, 2020

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

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Study Shows OTC Program Reduced Hospital Admissions By 39%

Thursday, December 3rd, 2020

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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Physician Is Seriously Pissed

Wednesday, December 2nd, 2020

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Quote & Bind Liability Insurance Online

Tuesday, December 1st, 2020

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Government Mandates Listed Price Must Be Paid By Health Plans

Tuesday, December 1st, 2020

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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