“Now you can earn $100 per enrolled employee for every NEW Small Group (5 to 50 employees) you enroll into our Anthem Balanced Funding (ABF) plans, through 6/1/22 effective dates. Thereʼs no cap on how much you can make.”
Month: April 2022
Maine Enacts Canadian Reference Pricing Law to Study Savings in Prescription Drug Costs
“Maine’s Democratic governor, Janet Mills, signed legislation directing the Maine Health Data Organization (MHDO) to report annually on the potential savings if certain drugs were subjected to a referenced rate, which is the lowest of the prices available among Canada’s four largest provinces and the wholesale acquisition cost, beginning January 1, 2023.” MORE >>
You Don’t Want To Miss Tomorrow’s TRS ActiveCare Board Meeting
Watch a health insurance renewal presentation on a 450,000 life case unfold before your very own eyes! Will rates go up? Will benefits reduce? Or will something magical happen?
Continue reading You Don’t Want To Miss Tomorrow’s TRS ActiveCare Board Meeting
4% Of American Hospitals Don’t Take BCBS & 5% of Doctors Don’t Either
“Blue Cross Members Get a Network with 95% of Doctors and 96% of Hospitals in the U.S.”
Continue reading 4% Of American Hospitals Don’t Take BCBS & 5% of Doctors Don’t Either
Adopting a “Pure” Reference-Based Pricing Strategy
“The most effective way to address the No Surprises Act (NSA) legislation, particularly elements of the Independent Dispute Resolution (IDR) process, may be to adopt a pure RBP plan that does not contract with providers……………….”
Continue reading Adopting a “Pure” Reference-Based Pricing Strategy
Life Insurance For Diabetics
Do you shudder when a prospect tells you they are diabetic?
TRS ActiveCare To Release 2022-2023 Renewal This Week
The open portions of the April 28, 2022, meeting are being broadcast over the Internet…….
Continue reading TRS ActiveCare To Release 2022-2023 Renewal This Week
1115 Waiver Remains Alive & Well in Texas
Texas hospital officials expressed relief that the future of the waiver was no longer in question but continued to push for other programs to help pay for the care of Texas’ uninsured population — the largest in the nation.
Aldeen’s Sunday Morning Bathroom Read
By Doug Aldeen on Linkedin
In Alec Baldwin’s iconic role in the seminal 1992 movie, Glengarry Ross, he advised his underlings to “always be closing ” (“ABC”). In Colorado, for hospitals under HB 1285, “ABC” =always be compliant… .
Employers Rejoice – Government To Grant Telehealth Freedom
Government To Remove ACA Handcuff?
The Telehealth Benefit Expansion for Workers Act would allow employers to offer standalone telehealth service programs……………
Continue reading Employers Rejoice – Government To Grant Telehealth Freedom
Direct Provider Contracts Will Be Secret No More……….
A reference based pricing plan having direct provider contracts is by definition a “network” plan. (See definition of “in-network” in Code of Federal Regulations, 147.210, XII) In that instance a plan sponsor must publicly display in-network information containing name, CPT code and negotiated rate and fee schedule rates.
Continue reading Direct Provider Contracts Will Be Secret No More……….
The Great Aldeenie Makes Television Debut
“Coming soon to a television near you: Our own Doug Aldeen is featured in this upcoming series on medical debt by our news partner KXAN TV in Austin, Tex.” – Jeanne Pinder – Founder, CEO, clearhealthcosts.com
Car Dealership Takes Different Approach To Health Care – And It Works
Car dealer’s approach to health insurance lifts employees and profits
As working Americans struggle to manage the rising cost of health care, one Lakeland car dealership has developed a new way of trying to close the door on higher costs.
Continue reading Car Dealership Takes Different Approach To Health Care – And It Works
My Plan Costs More Than Yours But It’s Cheaper
How do you compare financial performance between two group health plans? How do you determine which plan is outperforming the other in terms of dollars only?
Continue reading My Plan Costs More Than Yours But It’s Cheaper
Doctor Eschews Managed Care Bondage – Provides South Texans With Affordable, Easy Access Healthcare
“It’s easy to get Medicaid, for sure,” Dr. Lazzopina says. “But just because you have a card doesn’t mean you’re going to get an appointment, at least any time soon.”
What Will Texas Do? Expand Medicaid or Adopt A Better Strategy?
Is government health plan financing simply a price fixing scheme having little to do with supply and demand resulting in constricted access to care in an otherwise (almost) free market system?
Continue reading What Will Texas Do? Expand Medicaid or Adopt A Better Strategy?
“RBP is Dying, Or It’s Dead”
By Bill Rusteberg
Sometimes we read things and wonder “what the heck were they thinking when they wrote this? Is there something I’m missing here!”
John Kirke
John Kirke leads BevCap Management’s healthcare captive team, client services and growth strategies empowering clients to create value for their organization through healthcare benefits sponsored in stop loss captives.
The Mystery World of American Drug Pricing
A.J. Loiacono Doesn’t Mince Words
Trying to understand the mystery world of American drug pricing will drive one to the nut house faster than you can spell P-H-A-M-A-C-E-U-T-I-C-A-L-S.
Diagnosing Is Elementary Mr. Watson
By Bill Rusteberg
A patient in severe pain barges into the doctor’s office screaming “I need to see the doctor! I’m in pain, terrible pain! Please, tell the doctor I need help!”
The Society of Actuaries and Milliman Report on the DPC Model
The DPC Coalition and American Academy of Family Physicians spent two years in collaboration with Milliman and the Society of Actuaries on a comprehensive evaluation of Direct Primary Care (DPC) as a growing health care delivery and financing model.
Continue reading The Society of Actuaries and Milliman Report on the DPC Model
Ma’am, You Have A Premium Paying Policy!
By Bill Rusteberg
Years ago when I was a sales representative for a health insurance company a disgruntled plan member cornered me, screaming her claim was denied. “Our insurance sucks! I pay a lot of premium and I don’t get anything in return!” she screamed for all to hear.
Texas Government Health Plan Needs Immediate Life Support
Last fall the Texas legislature gifted the TRS ActiveCare health fund +$200,000,000 and called it “Covid Relief.”
Continue reading Texas Government Health Plan Needs Immediate Life Support
Lung Roach Disease
Skyward Specialty Insurance
Specialty is a growing specialty insurance Company, delivering commercial property and casualty products and solutions on a non-admitted and admitted basis.
Do Employers Now Have to Offer Affordable Family Coverage?
Santa & His 435 Elves (Congress) Declare Xmas In The Spring!
Other people’s money would help offset the high cost of coverage in employer-sponsored plans……….
Continue reading Do Employers Now Have to Offer Affordable Family Coverage?
How To Grow Your Business: Become a Buyer Not A Seller
Hub continues acquisition spree
by Ryan Smith 11 Apr 2022
Global broker Hub International Limited has announced that it has acquired the assets of Marketing Management Associates. The terms of the transaction were not disclosed.
Continue reading How To Grow Your Business: Become a Buyer Not A Seller
A Hospital Without Health Insurance – Vacation Paradise!
Dream vacation for the uninsured………………………….
Continue reading A Hospital Without Health Insurance – Vacation Paradise!
Whoa……….You Want How Much?
One hospital wants an 88 percent higher reimbursement for its providers in the next four years…………Another hospital wants a 30 percent overall rate increase, including a 50 percent increase for some services…………
Solving Health Care Inspires School Official To Earn Doctorate Degree
“I successfully defended my dissertation titled: A CASE STUDY OF GROUP HEALTH INSURANCE COVERAGE AT ONE TEXAS SCHOOL DISTRICT, earning an Ed.D. from Lamar University. My dissertation was a single case study of group health insurance coverage at Raymondville ISD. “ – Ben Clinton
Continue reading Solving Health Care Inspires School Official To Earn Doctorate Degree
Santa Claus Fixes The Family Glitch Using Other People’s Money
The Department of the Treasury (Treasury) notice of proposed rulemaking on the “family glitch” expands eligibility for free government money to employees’ families when their share of their employer-sponsored premium is deemed to be unaffordable by faceless bureaucrats in Washington.
Continue reading Santa Claus Fixes The Family Glitch Using Other People’s Money
DPC Math
A direct primary care organization (DPC) charges $60 per member per month or $720 per member per year. According to government statistics PCP visits per 100 = 136 or 1.36 visits per person per year.
In IRS First, Non-Profit Hospital Loses Status Under ACA Rules
Failure to comply with new community health needs assessment rules under the Affordable Care Act resulted in a non-profit hospital losing its tax-exempt status back in 2017. Has there been other cases like this since?
Continue reading In IRS First, Non-Profit Hospital Loses Status Under ACA Rules
Compliance with the Affordable Care Act and Final IRS Section 501(r) Regulations
Failure to meet these requirements can have significant consequences……………….
Continue reading Compliance with the Affordable Care Act and Final IRS Section 501(r) Regulations
Scouring For Dollars – Starring Doug Aldeen
Hospital Administrator & Family Attend Movie Premiere
What if you could protect employer health plans and their members from excessive and often incorrect hospital charges? Watch our fast-moving 30-minute video with Doug Aldeen, prominent healthcare and ERISA attorney, and learn how to challenge and change this costly dynamic.
Continue reading Scouring For Dollars – Starring Doug Aldeen
Hospital Fair Share Spending
“Recently we asked a not-for-profit hospital for a copy of their Financial Assistance Policy. Instead they directed us to their website where, they said, we could find all we needed to know about their Financial Assistance Policy. We did, and it didn’t. So we asked the hospital a second time for a complete copy of their Financial Assistance Policy. To date they have not responded. So, it’s been over 30 days now and it’s time to file a complaint with the proper federal authorities to remove their not-for-profit status. They can’t have their cake and eat it too” – Bill Rusteberg
A Hospital Bullied a Mom With an Overpriced Medical Bill. She Bullied ‘Em Back
Leslie Donovan followed the blueprint I laid out in “Never Pay the First Bill” to sue Sutter Health, leading to a refund and cleared balance.
|
|
Continue reading A Hospital Bullied a Mom With an Overpriced Medical Bill. She Bullied ‘Em Back
School District Seeks Student Insurance Proposals
Vendors, We are opening the bid for RFP-0422-SI, Student Insurance. Please go to the link below:
https://sbcisd.edlioschool.com/apps/pages/index.jsp?uREC_ID=900856&type=d&pREC_ID=2305758
Continue reading School District Seeks Student Insurance Proposals
RiskManagers.us Loses Key Staff Member
With great sadness we announce the passing of Nola Ortiz. Nola is survived by her three sisters, Ava, Allie and Anna and Boudreaux (Buddy) Wilson III.
Employers Beware: The Compliance Police Are Coming To Take You Away
Employers these days are subject to government oversight to an extent never envisioned by our Founding Fathers. Failure to comply with onerous government mandates can lead to crippling punishment at the hands of faceless bureaucrats lurking within the Deep State……………..
Continue reading Employers Beware: The Compliance Police Are Coming To Take You Away
Why Is Novolog On Your Formulary When Something Cheaper Isn’t?
By Scott Fuqua on Linkedin
(Experienced Healthcare Professional with nearly 25 years in the industry. RBR, Medical Bill Review, Cost Containment)
If PBMs could lower the cost, why are they not doing so? Just like the PPO Network middle men, the traditional PBM model is an absolute PROVEN FAILURE.
Continue reading Why Is Novolog On Your Formulary When Something Cheaper Isn’t?
Aldeen’s Sunday Morning Bathroom Read
Sunday Morning Bathroom Read, Spring Edition, Vol. 1, Article 1
“Now we can confirm why the person hit by the semi was marked as COVID on the death certificate” – Doug Aldeen