If direct pay models became commonplace, they would empower and liberate both patients and doctors and do more to bring down costs than other healthcare reforms.
Continue reading How Montana Is Revolutionizing Healthcare—With Markets
Month: October 2021
Mask Stupidity
Masks don’t work so why wear them? For those of you still wearing your Obedience Mask, how many more years are you going to wear them? Forever?
Found Money ? The Golden Goose WIMPER Plan
Imagine being able to provide more employee benefits for free at no cost to either the employer or employee. Sounds too good to be true doesn’t it? Well…………..you might be surprised or…..you might not…………….
Billionaire Investor Enters The Drug Business
“Is This Cuban’s IPO? Buy, Buy, Buy Now!”
Billionaire Mark Cuban’s New Firm Seeks to Reduce Drug Costs
When it comes to lowering America’s notoriously high prescription drug prices, who better to haggle on your behalf than a loud-mouthed NBA team owner best known for bullying referees and hosting a reality TV show?
Continue reading Billionaire Investor Enters The Drug Business
PBMs Must “Spill The Beans” Under Texas Statute
Now as a matter of public record you can find out more about your PBM’s revenue streams earned from pharmaceutical drug manufacturers under a Texas statute and TDI amendment to the Texas Insurance Code.
Continue reading PBMs Must “Spill The Beans” Under Texas Statute
San Antonio Walgreens Pharmacist Refuses to Fill Ivermectin Script…
Pharmacist takes the stance “Father Knows Best.” Patient says “You’re Not My Father!”
Continue reading San Antonio Walgreens Pharmacist Refuses to Fill Ivermectin Script…
How The Amish Defeated Covid without Vaccines…
Amish Covid — ‘No hospitalization, isolation or vaccines = herd immunity’
Continue reading How The Amish Defeated Covid without Vaccines…
Victor Manes Opines
Victor Manes, MBA
I AM STUNNED…..I have been in the Hospital Administration/Healthcare Contracting world for 30 years and it amazes me how Health Systems are still trying to hold on to their 1980’s mentality of offering contracts at a % of billed charges.
Walmart Increases Self-Funded Employer Access to Cost Effective Care
Self-insured employers will have access to Walmart’s retail and specialty pharmacy services, prescription drugs, telehealth services, optical care, over the counter services, and community health centers.
Continue reading Walmart Increases Self-Funded Employer Access to Cost Effective Care
Your Doctor Is Waiting For You In The Parking Lot
A healthcare system without waiting rooms…..
Continue reading Your Doctor Is Waiting For You In The Parking Lot
TRS ActiveCare Competes for Business
For the first time in 20 years TRS ActiveCare is Competing For Business.
Does TRS ActiveCare Non-Compete Agreement Trump Chapter 1501 of The Texas Insurance Code?
If a district requests a Blue Cross small group proposal is Blue Cross required to provide one or does the non-compete agreement preclude them from doing so?
FBS & Higginbotham Join Forces To Capture Texas School Business
Financial Benefit Services and Higginbotham Combine – Employee Benefits Firm in Richardson, Texas, Joins the State’s Largest Independent Insurance Firm
Continue reading FBS & Higginbotham Join Forces To Capture Texas School Business
Big Pharma & Plan Sponsors Are Co-Conspirators
By Molly Mulebriar
Big Pharma is taking advantage of us because we let them.
Continue reading Big Pharma & Plan Sponsors Are Co-Conspirators
ICHRA’s Are Looking Better Every Day Thanks To The MHPAEA
With more punishing government mandates why in hell would an employer continue to put his business at risk by continuing a traditional group health insurance plan when he could simply offer a defined contribution plan allowing employees to pick and choose individual coverage on the open market?
Continue reading ICHRA’s Are Looking Better Every Day Thanks To The MHPAEA
Pig donates kidney to United States Congressman
Amazing, breakthrough operation puts Congressman back into action……………
Continue reading Pig donates kidney to United States Congressman
You May Qualify For Free Hospital Care
The Affordable Care Act (ACA), enacted into law on March 23, 2010, added Section 501(r) requirements to the Internal Revenue Code that a 501(c)(3) tax-exempt hospital must satisfy to maintain tax-exempt status. The financial assistance policy (FAP) is a requirement mandated by the ACA and implemented as part of the IRS. As per IRS 501(r), an FAP must apply to all medically necessary care provided by the hospital.
Help Valley Baptist Hospital Fulfill Their Charitable Mission
Give Me Your Poor, Your Tired, Your Huddled Masses…………..
“You may qualify for hospital financial assistance if your household income is below 350 percent of the federal poverty limit or if your annual out of pocket medical costs exceeded 10 percent of your household income in the past 12 months.”
Continue reading Help Valley Baptist Hospital Fulfill Their Charitable Mission
An Arm and a Leg’: Hello?
The cost of money transfer under health insurance plans is +600% more than under a credit card transaction. Cash pay centric health plans cuts out all that wasted money……….
This agreement with Equity Healthcare marks another growth milestone for Centivo, which has now expanded into markets across the United States including Metro New York, Southern California, Central Florida, northern North Carolina, Nebraska, Iowa and Wisconsin.
ASC Sues Aetna Over “Mystery Repricing Program”
Aetna repriced $233,988 to $33,380. Inquisitive minds want to know why………….
Continue reading ASC Sues Aetna Over “Mystery Repricing Program”
Surprise Medical Bills & Reference Based Pricing
The old saying “The plan pays what it’s going to pay, nothing more and nothing less” will now have to necessarily say “The plan pays what an outside arbitrator says it will pay, nothing more and nothing less.”
Continue reading Surprise Medical Bills & Reference Based Pricing
Claim Audit Exposes Managed Care Reimbursement Levels
2016 audit of BCBSTX claims shows paid amounts for “emergent” services were in excess of ten times Medicare fees…….
Continue reading Claim Audit Exposes Managed Care Reimbursement Levels
Today’s Primary Care Problems Can Be Solved by Advanced Primary Care
Employers are ditching traditional care methods for Advanced Primary Care………….
Continue reading Today’s Primary Care Problems Can Be Solved by Advanced Primary Care
Former Insurance Commissioners Gets 7 Years In Prison
Georgia’s former insurance commissioner was sentenced Tuesday to just over seven years in federal prison and ordered to pay restitution of $2.6 million on 37 counts of mail and wire fraud, money laundering, and aiding the filing of false tax returns.
Continue reading Former Insurance Commissioners Gets 7 Years In Prison
Why Pay For Health Insurance For Those That Don’t Need It?
A Hidden Nugget In The Affordable Care Act
By Bill Rusteberg
A Plan Sponsor may be wise to consider a risk transfer strategy through a program created by the Affordable Care Act but which few plan sponsors are aware of.
Continue reading Why Pay For Health Insurance For Those That Don’t Need It?
Predicate For Vaccine Mandate is False
“If the proposed mandate cannot guarantee that the individual vaccine recipients are protected against breakthrough infection, nor prevent the spread of the infection to at-risk people (vaccinated or not), then the mandate is based on a false premise.”
Attention: Hospitals & Their Attorneys Are Prohibited From Reading This Blog
In deference to one of our three readers, effective immediately we are prohibiting hospital people and their attorneys from reading this blog.
Continue reading Attention: Hospitals & Their Attorneys Are Prohibited From Reading This Blog
Crack Healthcare Costs with Cash
Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…
Hospital Rejects 120% of Medicare, Accepts 105% Instead
Continue reading Hospital Rejects 120% of Medicare, Accepts 105% Instead
MediShield
An add-on service providing Reference Based Pricing legal support for possible balance bill escalations or litigation…………………
RxPharmacy Assurance Launches Innovative Stop-Loss Supplement to Manage Pharmacy Risk
A supplemental stop-loss product for unexpected and potentially catastrophic specialty drug claims? How’s that possible………………..?
How A West Texan Turned A Small Pharmacy Into A National PBM
Jerry Hodge had an opportunity and the vision it took to recognize it’s potential but he didn’t have the credit or the money to seize upon it.
Continue reading How A West Texan Turned A Small Pharmacy Into A National PBM
TPA Administrative Services Agreement
By Bill Rusteberg
Yesterday we reviewed a TPA Administrative Services Agreement. It was same old same old until we got to page 13.
Bureaucratic Red Tape Delays Compassionate Use Basis
By Marty Makary MD
If we wanted to, we could instantly slash daily Covid death rates in HALF (or more) with one pill.
Continue reading Bureaucratic Red Tape Delays Compassionate Use Basis
The Great Money Grab
Be Afraid, Very Afraid
By Molly Mulebriar
“You don’t want me to know your business because it won’t be good for you” said the physician group’s business manager some years ago.
RBP Vendor Offers More For Less
By Bill Rusteberg
As RBP grows so will the number of new entrants into the market with improved benefits and competitive pricing. That’s good for business.
Why Are Carriers Dragging Claims These Days?
Side note to the Kaiser article below brings two observations:
Continue reading Why Are Carriers Dragging Claims These Days?
Hospital System in Colorado to Refuse Organ Transplants to Those Without Covid Jab
A hospital system in Colorado has now announced that they will be refusing organ transplants to all patients who haven’t received a vaccination against Covid-19.
Continue reading Hospital System in Colorado to Refuse Organ Transplants to Those Without Covid Jab
Texas Businessman Reacts To Government Vaccine Mandate
The restaurant business is a tough business. Add to that onerous government mandates and it’s even tougher. But this restaurant owner has had enough……………….
Continue reading Texas Businessman Reacts To Government Vaccine Mandate
Chinese Flu Anti-Vax Punishment Ok’d by Government
Government dictates employers can punish employees who refuse to take a Chinese Flu vaccination…………….
Continue reading Chinese Flu Anti-Vax Punishment Ok’d by Government
Cash Beats Managed Care Plans Every Time
Removing Financial Barriers To Health Care
This is how to remove all financial barriers to healthcare, improve benefits, and save money at the same time.
What the Broker Compensation Disclosure Rule Means for Employers
Undisclosed broker compensation can be enormous. Take the case of a Texas public school district in the Lower Rio Grande Valley who thought their broker was earning $126,000 in fees.
Continue reading What the Broker Compensation Disclosure Rule Means for Employers
Have You Read Your RBP Contract?
Stop! Don’t Sign Until You Read It!
Years ago a client signed a contract before we had the chance to review it. When we did we found the vendor was royally screwing the client with new terms and conditions not memorialized in their winning proposal.
I asked the owner who happened to be an attorney too, “Did you read the contract before you signed it?” He bowed up and said “Yes, of course I read the contract!”
“Then why did you sign it?” I countered.
Plan Sponsor Refuses Advice and Pays Dearly For It
Please, Oh Please, Take This Advice
By Bill Rusteberg
It’s sad how much drugs are costing these days. Most plan sponsors are simply “sucking it up” and paying for these abusively high and egregious prices funded by rate increases passed on, in part, to plan members.
Continue reading Plan Sponsor Refuses Advice and Pays Dearly For It
Texas Broker Captures 150 School Districts
“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson
The Texas Schools Health Benefits Program (TSHBP) is a commercial health insurance program developed for Texas school districts by FBS, a Dallas insurance brokerage.
Wall Street’s Buying Up U.S. Health Care
What happens when Wall Street takes over health care? You may not realize it, but private equity firms — which invest money for wealthy individuals, pension funds and endowments — are buying up medical practices and hospitals all over the U.S., expecting a big return on their money.
Health Care Profits For Me, But Not For Thee
Companies and lobbying groups often paint their business foes as the primary problems with the health care system……………..
Continue reading Health Care Profits For Me, But Not For Thee