Consumers are responsible for all cost of goods and services they purchase including health care services. Health insurance by definition is a reimbursement scheme for covered medical goods and services.
It’s hard for commercial carriers to compete against the Texas government health plan for Texas school districts when rates are lower due to government subsidies and a legislative mandate that requires annual rate caps of no more than 10%.
In insurance defense attorney Dennis Kass’ world, litigation financing firms lurk behind the scenes, pushing plaintiffs to undergo as much treatment as possible so lawyers can maximize the value of claims.
“A buzz is growing in ERISA legal circles as the Schlichter Bogard law firm sends LinkedIn solicitations asserting potential misconduct by the health plans sponsored by State Farm, Target, and other companies.”
Your patients can now have hospital-level care at home
Globally, more and more people accept and use digital healthcare. This helps to keep patients safer and it eases the burden on increasingly overwhelmed healthcare systems. This shift has highlighted the patient’s home as an important and relevant place to deliver healthcare.
A group insurance captive is a strategic healthcare funding arrangement between multiple like-minded employers. Together, these employers can pool risk, leverage economies of scale, and create their own high-performing health plan.
A Cuero, Texas based company’s self-funded group health insurance plan renews next month. Most of their employees use the local hospital in this one hospital town. Which carrier has the best prices at the town’s only hospital?
“Apollo Vanguard’s mission is to help individual patients and self-insured employer health plans acquire the same prescription drug brands without compromising quality and affordability. Our group supplies over 10,000 medications including same brand prescriptions available in the United States with tremendous savings of between 40% to 60% lower cost.” – Armando Polanco
Back in 2007 nay sayers predicted Reference Based Pricing would never work. BUCA reps and their hospital partners circled the wagons with dire warnings to plan sponsors with the threat plan members would not be able to access care.
“J.J. Garza came out on camera talking about the money he received and how he would explain it if it ever came up.” – Javier Pena, Attorney
You can have 100% backing from administration but it takes four votes to get a school district contract. If administration has strong leadership you have a good chance of successfully counting to four. If administration leadership is weak you have an uphill battle unless you’re successful in doing something really stupid.
“The only way that we would be able to get into any school district was to be able to directly have a relationship with the decisionmakers — the school board, the trustees” – Josh Cerna, Convicted Felon
Advanced Medical Pricing Solutions Appoints Matt Brow as Chief Executive Officer and Board Member
MyHealthGuide Source: Advanced Medical Pricing Solutions (AMPS), 7/12/2023
Kirk Fallbacher to Continue as President of Drexi, Board Member and Member of the Leadership Team
PHOENIX — Advanced Medical Pricing Solutions (AMPS), a Cimmaron Healthcare Capital portfolio company focused on supporting self-insured employers and healthcare stakeholders in providing affordable, fair, and transparent medical and prescription benefits, announced the appointment of Matt Brow as Chief Executive Officer and Board Member.
Region One 2023 School Finance & Operations Conference
Texas school districts are struggling to maintain affordable health care for their employees and their family members. Many districts are considering alternatives to TRS ActiveCare. Some have succeeded, while others have failed.
“Losing patients to competitors is known as “leakage.” Hospitals, in response, use an array of strategies to encourage “keepage” within their systems, which in recent years have expanded their array of services.” – David Russo, D.O.
Fiduciary liability insurance is a type of insurance coverage that protects businesses and organizations from financial losses resulting from claims of breach of fiduciary duty, errors in plan administration, or other acts of negligence related to the management of employee benefit plans.
Price fixing, working the spread, collusion and other nefarious activities driving up health care costs to the benefit of third party intermediaries is becoming an increasingly lucrative target for plaintiff attorneys.
New disclosure rules apply only to ERISA groups. That’s good news for conniving insurance brokers working public sector groups. Cities, counties and school districts are not governed by ERISA so it’s business as usual………………..
Seyfarth Synopsis: In light of a recent focus on price transparency, claims data, and hidden fees in the health plan world, employer-sponsored health plans have been bringing their fight to the courtroom in an effort to lower costs and demonstrate good fiduciary governance.
If you live in or near Amarillo, and you’d like to help your employees save on prescription drugs, and you’d like to see more healthcare dollars remain with local businesses, we’ve got a solution for you.
For some group health plan fiduciaries, there could be a storm brewing. Changes to the Employee Retirement Income Security Act of 1974 (“ERISA”), buried within the 5,593 pages of the Consolidated Appropriations Act, 2021 (“CAA”), create the possibility for a new set of potential plaintiffs in fiduciary litigation.
Selecting an insurance advisor is an important first step in managing a group medical program. Criteria usually revolve around several factors including compatibility. Corporate philosophies of the employer and insurance advisor should harmonize.
We are a concierge service that works with self-insured employer groups to help direct their members to our direct contracted providers. We keep costs down for employees as well as the employer by working with high-quality, transparent partners.
You’re at the grocery store. The cashier finishes ringing up the total. Instead of handing you a paper itemization memorializing the transaction, it is sent electronically into the nether world at the same time you insert your bank card into a machine linking the grocery store with someone else’s bank account. No copay needed. The bill is paid in full instantly. No balance billing. If the Food Stamp program can do this, why can’t your health plan?
Kerecis has developed and patented a technology platform based on intact fish skin from wild Atlantic cod, which is being used to treat burns and other complex acute and chronic wounds including diabetic, venous, trauma, and surgical wounds.
Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.
With their financial backs to the wall, surrounded by disgruntled workers who can’t afford the company’s health plan anymore, plus can’t afford to use it, more plan sponsors are leaping into shark infested waters while others are tip toeing through the tulips in search of alternatives.
“Have you been pitched a FICA-reduction program recently? If so, it’s a run-don’t-walk situation…….The programs are also marketed as no-cost to the employer, with the vendor being compensated by part of the FICA savings……..If these programs sound too good to be true, it’s because they are…..”
“I don’t think what we call “primary care” in the Fee For Service model can even be called *primary* when it’s tough to get into and is designed as a referral machine to price-gouging overlords.” – Dave Chase