Relating to the definition of emergency care for purposes of certain health benefit plans…..

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Pharma Witch Brews New Specialty Drug

Excluding or Carving-Out Specialty Drugs – “When specialty medication is excluded from the covered benefit, the member is completely on their own to cover the expenses for their specialty medications”.

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 A report, issued by a mysterious group of 30 unnamed patient organizations warns consumers to avoid these plans – and a call to action to lawmakers to step in and end them………….

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A BRAZILIAN man with an upside-down head has revealed his terror of catching the Chinese Virus.

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Happy Hour Outline of The Lisa Plan

The Lisa Plan is the future of healthcare financing. It makes sense for all the right reasons. Providers win, patients win, and employers who fund all of this win too.

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Cash pay centric health plans, coupled with PCP medical  homes is the future of employer sponsored healthcare. And the future is NOW!

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Senate Bill 1684l is action packed with many items of interest particularly to Reference Based Pricing plans and includes, among other things, this:

Hospitals must list the gross charges for each health care service provided by the facility with the Medicare reimbursement amount for the health care service next to the relevant gross charges.

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Government subsidized individual health insurance creates an unfair advantage for private employer sponsored health plans……………

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Managed Care Rep. Reacts

Most group plans will be required to provide members (1) In-network provider rates for all covered items and services (2) Out-of-network allowed amounts and billed charges for all items and services and (3) Negotiated rates and historical net prices for covered prescription drugs.

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Holy cow: 42% of Americans report undesired weight gain during Covid 19. The average weight gain is 29 lbs. And 41 lbs for Millennials! This will ramify for years to come.

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A recent Supreme Court case in Texas involving a hospital lien held that contract payments involving Medicare multipliers and other accepted payments could be evidence of reasonable, fair market value.

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Plan Sponsor takes another hit from Prescription Queen

“The fact that a drug is 10% higher in cost or in price than last year, it doesn’t mean it’s 10% more effective. It just means that because payers are willing to pay for them, that [the drug makers] keep increasing the price”

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The World Health Organization (WHO) has developed a list of essential medicines that “satisfy the priority health care needs of the population.”

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GoodRx co-founder Doug Hirsh once said: “A company like ours should not have to exist.”

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By Molley Mulebriar

“This nightmare scenario is something that’s been happening to more and more pharmacies over the past few years. It’s part of a widely reviled practice called “clawbacks” — fees, often totally unpredictable, that PBMs charge pharmacies to “claw back” some of the money they’ve already paid them in reimbursements.”

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When a Doctor Prescribes You a Medication, Look It Up on the GoodRx App While Still in the Examining Room.

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San Antonio’s sick & safe leave benefits ordinance would have required private employers to provide certain paid sick and safe leave benefits to employees based on hours worked within the city limits.

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“Skin In The Game” in health care spending really means the misguided hope of wise consumer spending using thousands of dollars they don’t have. But on the other hand having no “Skin In The Game” ends with the same results. In the later case Fat Albert would be wearing some outstanding duds courtesy of other people’s money.

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Taking a high cost maintenance, brand or specialty medication?

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Price of Drugs Is Too Damn High!

By Bill Rusteberg

High cost specialty drugs can bankrupt a self-funded plan, even if you have stop loss cover. It’s just a matter of time. So do you act now to preserve your plan or do you wait until it’s too late?

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“Plan administrators should identify the individuals who will need to receive a notice about the new subsidy…. Generally, this means anyone who had — or could have had — COBRA as far back as November 2019, because their 18 months of coverage would extend through April 2021.”

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“There has been a lack of transparency in the bidding process that has caused some of us concern about how rates with such a large pool of people continue to climb at exorbitant levels………… And the sheer fact that I believe with local control we can actually reduce some of those rates and maintain, if not improve upon, the benefits, it’s something we need to look at.”

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Employer built health care vs carrier built health care……………….

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Most Americans are insured through their employer’s health plan. The problem is most employers don’t treat healthcare like they do every other purchase. Those few that do reduce their costs by as much as 50% while improving benefits at the same time.

They know the cost of health care has remained essentially static for the past 15 years or more while the cost of health insurance hasn’t. They know because they took the time and effort to educate themselves as to the true cost drivers of health care enabling them to take corrective action.

They took the time and effort because they are the only employers that truly care about their employees (and their bottom line).

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HB 410 is the first TMA-supported prior authorization bill this session to get a hearing, but it’s just one piece of TMA’s broad offensive on the practice.

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A Texas School District Finds Comprehensive Benefits Packages

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Insurance companies will benefit most by receiving even larger government subsidies on behalf of people who already have coverage,

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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?”

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Unless you’re intellectually bleached, actuary work in forecasting medical trends and rating basis is not rocket science. Manipulation of value parameters is made easier with a Dial A Matic.

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Over 140 Texas school districts now offer a TRS ActiveCare commercial health plan alternative, effectively challenging the TRS ActiveCare mandate prohibiting member districts from doing so.

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Drug kickbacks / commissions (rebates) can account for about 20 – 30% of an employer’s drug spend…….

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As consumers, we do have the power to say that hospitals and some doctors have been riding the gravy train on the backs of American employers for far too long, and it is time to derail it.

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Courtesy Timer For New Yorkers (Not For Use In South Texas – It doesn’t Snow There)

The following is a true story:

By Molly Mulebriar

I dialed the number and almost immediately the mark answered with “I’ll call you back in ten minutes!”

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We are pleased and honored to announce David Rendall has been selected as the recipient of the prestigious 2021 CEO Today Global Award for North America. The influential CEO Today magazine recognizes and honors the most respected international business leaders and singles out those who consistently disrupt the industry’s status quo to lead their company to new levels of innovation and growth.

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Liz Wilson

You can earn $6,000 on average when you sell a Funding Advantage level funded plan for a 15-person group – more if you add dental and vision. If you need more compensation, just tell us the amount you need and we’ll build it in.

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Stetson Roane is an exceptional leader who doesn’t understand the concept of “It Can’t Be Done.”

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What did the governor just announce Tonto?

Tonto convinces Texas governor to reaffirm Texas independence…….Will other states follow?

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Four years later and a (cough) amount of money, here we are . . . and the results are better than anyone could have imagined………………

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Victor Lustig was a world class hustler in his time but he never had an opportunity like this one……….

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Hospital Administrator Reacts To Study

Study shows total health care spending for the privately insured population would reduce 41% if employers and other insurers reimbursed health care providers at Medicare rates. 

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