Archive for October, 2021

ASC Sues Aetna Over “Mystery Repricing Program”

Saturday, October 16th, 2021

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

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Surprise Medical Bills & Reference Based Pricing

Friday, October 15th, 2021

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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Claim Audit Exposes Managed Care Reimbursement Levels

Thursday, October 14th, 2021

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

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Today’s Primary Care Problems Can Be Solved by Advanced Primary Care

Wednesday, October 13th, 2021

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

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Former Insurance Commissioners Gets 7 Years In Prison

Wednesday, October 13th, 2021

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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Why Pay For Health Insurance For Those That Don’t Need It?

Tuesday, October 12th, 2021

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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Predicate For Vaccine Mandate is False

Tuesday, October 12th, 2021

“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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Attention: Hospitals & Their Attorneys Are Prohibited From Reading This Blog

Monday, October 11th, 2021

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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Crack Healthcare Costs with Cash

Monday, October 11th, 2021

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…

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Hospital Rejects 120% of Medicare, Accepts 105% Instead

Monday, October 11th, 2021

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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MediShield

Sunday, October 10th, 2021

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

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RxPharmacy Assurance Launches Innovative Stop-Loss Supplement to Manage Pharmacy Risk

Sunday, October 10th, 2021

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

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How A West Texan Turned A Small Pharmacy Into A National PBM

Friday, October 8th, 2021

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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TPA Administrative Services Agreement

Friday, October 8th, 2021

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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Bureaucratic Red Tape Delays Compassionate Use Basis

Friday, October 8th, 2021

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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The Great Money Grab

Thursday, October 7th, 2021

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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RBP Vendor Offers More For Less

Thursday, October 7th, 2021

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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Why Are Carriers Dragging Claims These Days?

Thursday, October 7th, 2021

Side note to the Kaiser article below brings two observations:

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Hospital System in Colorado to Refuse Organ Transplants to Those Without Covid Jab

Wednesday, October 6th, 2021

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.

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Texas Businessman Reacts To Government Vaccine Mandate

Wednesday, October 6th, 2021

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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Chinese Flu Anti-Vax Punishment Ok’d by Government

Wednesday, October 6th, 2021

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

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Cash Beats Managed Care Plans Every Time

Monday, October 4th, 2021

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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What the Broker Compensation Disclosure Rule Means for Employers

Monday, October 4th, 2021

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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Have You Read Your RBP Contract?

Sunday, October 3rd, 2021

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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Plan Sponsor Refuses Advice and Pays Dearly For It

Sunday, October 3rd, 2021

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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Texas Broker Captures 150 School Districts

Saturday, October 2nd, 2021

“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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Wall Street’s Buying Up U.S. Health Care

Saturday, October 2nd, 2021

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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Health Care Profits For Me, But Not For Thee

Friday, October 1st, 2021

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

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