Aetna repriced $233,988 to $33,380. Inquisitive minds want to know why………….

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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.”

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2016 audit of BCBSTX claims shows paid amounts for “emergent” services were in excess of ten times Medicare fees…….

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Employers are ditching traditional care methods for Advanced Primary Care………….

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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.

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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.

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“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.”

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In deference to one of our three readers, effective immediately we are prohibiting hospital people and their attorneys from reading this blog.

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If a hospital rejects 120% of Medicare reimbursement and turns non-emergent patients away, why do you think the same hospital would accept 105% instead?

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An add-on service providing Reference Based Pricing legal support for possible balance bill escalations or litigation…………………

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A supplemental stop-loss product for unexpected and potentially catastrophic specialty drug claims? How’s that possible………………..?

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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.

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By Bill Rusteberg

Yesterday we reviewed a TPA Administrative Services Agreement. It was same old same old until we got to page 13.

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By Marty Makary MD

If we wanted to, we could instantly slash daily Covid death rates in HALF (or more) with one pill.

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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.

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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.

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Side note to the Kaiser article below brings two observations:

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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……………….

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Government dictates employers can punish employees who refuse to take a Chinese Flu vaccination…………….

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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.

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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.

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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.

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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.

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“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.

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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.

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Companies and lobbying groups often paint their business foes as the primary problems with the health care system……………..

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