“Drug Prices Are Too Damn High”
The most recent West Health and Gallup survey reports that 7% of U.S. adults were unable to pay for at least one prescription medication between March and June of 2021.
Month: September 2021
Sad Story With Happy Ending
When Warner saw that his insurance company paid nearly $17,000 toward the $54,000 charge for a covid test, he first thought: “At least I’m not liable for anything”
Innovative Risk Sharing Strategy You’ve (probably) Never Heard Of…………
“Granular Insurance places self-funded employers on a path of certainty with its multi-year rate and benefit guarantee: a meaningful cap on annual premium increases with moderate and predictable changes to an employers’ spec.”
Continue reading Innovative Risk Sharing Strategy You’ve (probably) Never Heard Of…………
RBP PPO Wrap For $1.50 PEPM
We’ve learned there is a national PPO network active in all 50 states that works as a wrap to RBP plans for an access fee of $1.50 PEPM. This network is Medicare based and has negotiated direct provider agreements at less than 200% of Medicare.
H.H.C. Group Provides Professional Claims Negotiation
Professional claim negotiators can often resolve balance billing issues in five days or less………..
Continue reading H.H.C. Group Provides Professional Claims Negotiation
How One Texas School District Revolutionized Healthcare for Schools
Tired of waiting for the Texas legislature to act in addressing crippling health care costs affecting hundreds of thousands of Texas educators, in 2019 the Raymondville Independent School District in deep South Texas decided to act.
Continue reading How One Texas School District Revolutionized Healthcare for Schools
Rx Manage
This Rx program can be offered alongside any PBM administered plan. Rx savings are significant.
Removing Financial Barriers To Health Care
A primary care centric model coupled with directed referrals and cash pay strategies is the best way to lower costs, improve benefits (by removing financial barriers to healthcare) and improve member satisfaction. Why not try it?
Centivo Raises Additional $51 Million
Centivo’s market momentum is verified by significant savings and improved clinical results………………….
On-Line Pharmacy Delivers Rx Savings
AFFORDABLE MEDICINE FOR ALL
Your online pharmacy for low-cost, generic medicine, delivered right to your door – all without asking for your insurance information.
Chinese Flu Crib Sheet
The survival rate of “Covid” is over 99%. Government medical experts went out of their way to underline, from the beginning of the pandemic, that the vast majority of the population are not in any danger from Covid.
HMS
We make healthcare work better for everyone. By reducing costs and improving health outcomes, HMS advances the healthcare system.
340b Benefits Who?
The 340b program has become a huge revenue generator for health systems, PBM’s, and other intermediaries.
Grab Your Share of $345,000,000 Today!
“We getting a refund Bruno? That’s cool!”
There is a class action lawsuit settlement of $345m reached between the plaintiffs (Pfizer & King Pharma) and any person or entity that purchased brand or authorized generic Epipens between 8/4/2011 and 11/1/2020.
2022 Onsite Employee Health Clinics Summit
Onsite employee health clinics have proven to be an effective way to significantly reduce healthcare costs, and ultimately, have a positive impact on the company’s bottom line.
Direct Primary Care Rocks
Primary care physicians can treat 90% of what ails you. Direct primary care is a model that makes sense and saves money, provides better personal service grounded upon a holistic health care approach.
Mike Dendy on Reference Based Pricing
By Mike Dendy
Reference based reimbursement (RBR or RBP) has evolved over the past 10 years and there are now many more players in the space.
Doctor Arrested For Prescribing Ivermectin
Dr. Jean-Paul Theron was arrested for prescribing Ivermectin from his home. He was targeted by a complaint from the Council of the Order of Physicians…….. Continue reading Doctor Arrested For Prescribing Ivermectin
Dentists Chip Away at Uninsured Problem by Offering Patients Membership Plans
“Patients on membership plans act like insured patients and come in as much as insured patients, but they pay less for coverage while dentists get paid more,” said CEO Dave Monahan. “All we are doing is cutting out the middleman,” he said.
Continue reading Dentists Chip Away at Uninsured Problem by Offering Patients Membership Plans
Sex Sells – Winning Sales Quota by Banging Doctors?
In 2012, Insys hired a new sales executive: Sunrise Lee, a Florida escort service manager and former strip club dancer with no academic degree, according to Guzman’s complaint. Burlakoff allegedly defended the decision, claiming, “Doctors really enjoyed spending time with her and found Sunrise to be a great listener.” He added, “She’s more of a closer.”
Continue reading Sex Sells – Winning Sales Quota by Banging Doctors?
Dallas Risk Management
Dallas Risk Management (DRM) is a Managing General Underwriter, or MGU, for health insurance policies.
Key House Democrats Block Biden Drug Price Controls
Embodiment of Corruption: Your Health Insurance Network
Secret network pricing helps render patients defenseless against price gouging. It’s as absurd as grocers being permitted to keep the price of milk secret……………..
Continue reading Embodiment of Corruption: Your Health Insurance Network
Texas Hospital Faces Closure Over COVID-19 Vaccine Mandate: CEO
“What happens to individual choice and medical decisions between the patient and their doctor, which is all of the things that we’re trying to support.”
Continue reading Texas Hospital Faces Closure Over COVID-19 Vaccine Mandate: CEO
TRS ActiveCare Will Remain The Choice of +90% of Texas School Districts
For the first time in 20 years TRS ActiveCare member districts will be allowed to opt out of the program effective September 1, 2022. In our opinion most member districts will remain in TRS ActiveCare.
Continue reading TRS ActiveCare Will Remain The Choice of +90% of Texas School Districts
Why Most Public School Districts Get An “F” In Health Care Management
By Bill Rusteberg
School districts are entitlement based bastions whose decision making processes heavily weight social considerations at the expense of prudent business practices.
Continue reading Why Most Public School Districts Get An “F” In Health Care Management
Fellow Health Care Disruptor Shares Personal Experience
A friend, fellow health care disruptor and collaborator shared his personal experience navigating the American Health Care System in an email sent us this afternoon.
Continue reading Fellow Health Care Disruptor Shares Personal Experience
U.S. v. Teva Pharmaceuticals USA Inc et al
Lawsuit alleges the company illegally paid two purportedly independent charitable foundations $328 million from 2006 to 2015 to cover co-payments of Copaxone patients, while Copaxone’s price quadrupled to $73,326 a year.
Paul Keckley – Trusted Advisor
Paul Keckley is an intense observer of that change, diving deep into the trends, tipping points, intended and unintended consequences to bring clients and opinion leaders the unvarnished truth.
Customers Get Fired Too…………
By Dan Meylan
“In 5 decades of operating agencies and other businesses….we always looked for ways to remove unprofitable clients….”
Pissed Off Plan Sponsor Has Had Enough!
Pissed off plan sponsor has had enough! Their TPA has not lived up to expectations and a warning shot has been fired across the TPA’s bow……………
American Health Care System Drives Man To Drink
Employee Benefits International
Employee Benefits International is headquartered in Phoenix, Arizona, and covers the entire United States with health insurance and employee benefits programs for businesses – large and small. EBI has experts in-house that have worked with most business sectors including: healthcare, law firms, construction, manufacturers, nonprofits, auto dealerships, Realtors, and many others.
Legendary Insurance Agents You Never Heard Of
“Rosengard is known for putting together what was for a long time the world’s largest life insurance policy, still recorded by Guinness Book of Records.”
Continue reading Legendary Insurance Agents You Never Heard Of
CPO Centric Health Plan
By Bill Rusteberg
A CPO (Cash Pay Option) centric health plan removes all financial barriers to health care while saving money at the same time. Cash beats insurance everytime.
Selecting a Third Party Administrator
By William Rusteberg
With the growing suggestion that the BUCAs are inflexible third party administrators unwilling and unable to administer Reference Based Pricing plans and other strategies in the market today, more brokers are seeking new partnerships with independent third party administrators (TPA). An independent TPA can offer much more than a traditional carrier model.
La Joya ISD Shit Show Continues………………..
FBI agent and a law enforcement officer from the Texas Department of Insurance watched quietly from the gallery as the the never ending La Joya Shit Show Continues…………….
Politicians Begin Watering Down Efforts To Lower Drug Pricing
Senate drug pricing bill may not apply to those with job-based insurance
Continue reading Politicians Begin Watering Down Efforts To Lower Drug Pricing
Rx Rebates 101
The role of rebates in drug coverage decisions and insurer finances…………
What Ever Happened To………………………?
Apr 12, 2018 · An insurance broker who admitted paying bribes to land lucrative health insurance contracts at area school districts and the now-defunct water utility was sentenced to 37 months in prison.
Medicare Is Running Out of Money
Medicare is running out of money. That’s not news to plan sponsors. They too are running out of money to fund the American health care beast. Some propose “Medicare for All” as the solution. Others say “Let the free market handle the problem!” The problem is there is no free market in health care and Medicare is running out of money because government doesn’t know how to solve health care either. Meanwhile, a few plan sponsors have solved health care the old fashion way using traditional American business practices based on common sense, reason and logic.