Wheelchair mechanics salivate over $736,072 World Record Wheelchair Repair……..Continue reading The World’s Most Expensive Wheelchair Repair
SOURCE: BowTie Medical
The independents are a Plan Sponsor’s best partner. Build your plan around them and watch what happens.Continue reading 74% of Doctors are Now Employed by Hospitals
“Imagine health care providers getting paid instantly at the point of service, bypassing all the traditional value extracting middlemen skimming off the top.” – Michel de Nostredame, 1565Continue reading FedNow – The Future Of Health Care Transactions?
Short sighted opportunists after a quick buck are never around in the long run…..Continue reading How A Used Car Salesman Sells Health Insurance
It will cut approximately 11% of workforceContinue reading Farmers To Slash 2,400 Jobs
The latest location with wind speed and sea surface temperature forecast in Tomer Burg’s forecast map. Idalia now a hurricane and could be a multi-billion dollar event for re/insurersContinue reading Idalia Could Be A Multi-Billion Dollar Event For Re/insurers
Houston Woman Dies After Getting Cheap BBL in Mexico
Complications from a Brazilian Butt Lift (BBL) procedure led to the death of a Texas woman.Continue reading Brazilian Butt Lift Kills Texan
“All my medical training told me you were either alive or dead. There was no in-between. But suddenly, I was reading from a cardiologist describing patients who had died, then come back to life, reporting very distinct, almost unbelievable experiences.”Continue reading Life After Death
America’s federally sanctioned entitlement programs, Medicare, Medicaid, and Social Security, each face bankruptcy in the next few years. Medicare and Medicaid were created in 1965 as part of President Lyndon Johnson’s Great Society legislation. Social Security was created in 1935 to provide retirement income for Americans who reached the age of sixty-five. These three entitlement programs consume about fifty cents of every federal budget dollar, or $2.7 trillion in fiscal year 2023.Continue reading America’s Big Three Entitlement Bankruptcies Are Inevitable
What an easy question! First they arbitrarily inflate the price…………Continue reading How Do PBMs Get Away With It?
Referred by Ron Barshop
Montgomery County has saved $10-$12 million on urgent care visits and $100,000 in labs which has kept medical spend flat for two years.Continue reading Texas County Enjoys Flat Medical Spend
Next Friday the largest employer south of San Antonio will be conducting a public interview of 14 vendors who responded to their Request For Proposals for administration of their self-funded health plan. This poses an excellent opportunity to ask questions, an opportunity not to be wasted.Continue reading Brownsville ISD To Enter The World of Aquarius
Another Sunday Bathroom Read By Doug Aldeen – A Weekly Series
“The New York Times reported in June that Minneapolis-based Allina Health had an explicit policy to cancel outpatient appointments for patients with at least $4,500 in unpaid medical debt.”Continue reading Aldeen’s Sunday Morning Bathroom Read
The bill allows veterans the option to enroll in direct primary care……Continue reading Chip Pushes DPC For Veterans
You don’t know who you hired but you sure as hell know who you fired……………Continue reading Hiring Anyone By Default Is Never A Good Idea
List prices in other nations are significantly 10 times less: In France, Australia, the U.K., Sweden the Netherlands and Germany, Ozempic is between $80 and $100, according to the analysis.Continue reading U.S. Drug Prices Are Outrageous
Claire Wallace – Wednesday, August 23rd, 2023
Ludwig Theodor Braun, 33, is the world’s youngest billionaire who earned his fortune in healthcare, according to Forbes’ live net worth tracker.Continue reading Meet The World’s Youngest Healthcare Billionaire
You Want How Much!
If people would shop around for health care like they do for everything else they would be amazed at the savings they can achieve.Continue reading Pool Filter Insurance Anyone?
Do you ever set the “Rules of the Game” with your prospects BEFORE you go through the quoting process? You should! If you don’t, this will happen…Continue reading Set Rules Before Engaging A John To Avoid An Uncompensated Screwing
That next wave of fiduciary litigation seems to be expanding, based on social media outreach by the law firm of Schlichter Bogard.Continue reading Lawyers See Gold In Them Darn Hills Yonder
If you want to know why employers must provide benefits…….Continue reading If You Want To Know Why………..
Cela va vous énerver énormément …………………….
A one-month supply of Ozempic has a list price of $936 in the U.S., according to the report, while it cost just $83 in France and $87 in Australia.Continue reading Ozempic – Parlez-vous Français ?
Give the Hospitals a Taste of Their Own Medicine – Hire CareGuides Advocates CGA helps save money before and after care occurs.Continue reading “The Only Thing A Son-Of-A-Bitch Understands Is Another Son-Of-A-Bitch”
The problem is there is no such thing as being half pregnant. A half pregnant approach only extends and aggravates any pain associated with change and simply takes longer than necessary to achieve the end goals which are lower costs, better benefits and higher wages.Continue reading Cliff Dwellers or Half Pregnant Tulip Lovers?
“We don’t cover specialty drugs”
Plans requiring members to seek manufacturer patient assistance for expensive specialty drugs as a prerequisite for coverage through a side agreement have caught the attention of pharmaceutical manufacturers.Continue reading We’re On To Your Specialty Drug Strategies!
Use the chart below to develop composite rates for a typical RBP plan. Then compare to your tradition managed care plan. This will give you an idea of the savings to be achieved.Continue reading Field Rate A RBP Group Plan
“Where you go for health care is your business, how it’s paid is ours” – Bill RustebergContinue reading Ending Discrimination In Healthcare
CARDINAL HEALTH: Profits Up – Posted on August 19, 2023 by Dr. David Edward Marcinko MBA – By Staff Reporters
Pharmaceutical distributor Cardinal Health raised its 2024 profit expectations following strong demand for generic and specialty drugs such as GLP-1 medications, the company announced in its Q4 2023 earnings call.Continue reading Drug Dealer Enjoys Higher Profits
Beware! Monsters and Demons lurk behind Door #3
DOOR # 1
The Oxbridge platform has been designed to move up to 50% of an employer’s annual health benefit spending into episode of care programs. This enables a radical level of transparency into the underlying costs of care and gives covered beneficiaries a way to avoid the crushing out of pocket costs that have become standard in traditional HMOs and PPO plans. Episode Benefit Plans represent the first truly unique new health benefit offering since the introduction of PPOs and Point of Service Plans in the late 1980s.Continue reading What’s The Message Behind Doors #1 & 2?
By Patrick Henry
Plan sponsors must weigh the difference between government diktats and pragmatism tied to personal beliefs and monetary constraints.Continue reading Maintaining Grandfather Status
“The decision was partly driven by CVS’ hesitancy earlier this year to cover a cheaper generic version of Johnson & Johnson’s prostate cancer drug Zytiga……”Continue reading Why Blue Shield of California Ditching CVS Could Upend Drug Plans
Article Referred by Bob Calvisi
“MultiPlan knows it can get away with acting, in the words of an analyst, ‘like a mafia enforcer for insurers,’ because virtually every commercial healthcare payor has agreed to use its repricing methodology, leaving healthcare providers with no practical option but to accept the ‘repriced’ reimbursement amount that MultiPlan imposes……….”Continue reading Multiplan Cartel – “Mafia Enforcers For Insurers”
More plan sponsors are wondering why they are covering brand name and specialty drugs when there are over 32,000 generic drugs to choose from.Continue reading There Are Over 32,000 Generic Drugs & +90% Cost Less Than $20
Not for profit hospitals like this one don’t pay taxes. In return Uncle Sam mandates they must have a financial assistance policy in place to help those in the community who can’t afford health care. A $2.5 billion hospital is probably gonna be some kind of expensive for most people, even those with health insurance.Continue reading Not For Profit Hospital To Build $2.5 Billion Facility In Austin, Texas
A True Story
Take a ten second decision where everyone wins and nobody loses to a political subdivision then start your stop watch. You will be amazed how long a 10 second decision actually takes.Continue reading How To Stretch A 10 Second Decision To Infinity
Billy is a new website that allows you to compare hospital prices for healthcare services. The prices are based off of hospitals’ own pricing data that the Federal Government requires them to release to the public.Continue reading Billy Eats Your Medical Bills
“You really don’t understand, do you? If we approve expensive drugs, then the system goes broke. Then no one gets healthcare……Plus, if I approve too many expensive drugs, I won’t get my bonus at the end of the month. So giving out too many approvals wouldn’t be a smart thing for me to do. Would it?”Continue reading Milton Thinks You Should Know How The System Works
A powerful lobbyist convinced a federal agency that doctors can be forced to pay fees on money that health insurers owe them. Big companies rake in profits while doctors are saddled with yet another cost in a burdensome health care system.Continue reading The Hidden Fee Costing Doctors Millions Every Year
By Chris Deacon on Linkedin
This may be one of the most important stories of this year, if not the most important. Not because it highlights one more way insurers and middlemen extract vast profits from the healthcare industry. Rather, it perfectly illustrates why trust in the system and its regulators is beyond broken.Continue reading The Most Important Story of This Year
There’s something about West Texans. They’re different.Continue reading West Texans
Kraft Heinz Sues Aetna Health Insurance Company… Why Now? Kraft Heinz claims that Aetna inappropriately administered their employee health plan since 2012.Continue reading Kraft Heinz vs Aetna…..Why Now?
“Plan sponsors may be exposed to fiduciary liability of their own if they do not pursue claims against their TPAs for excessive fees and fraudulent practices”Continue reading Excessive Fee Litigation Spreads to Self-funded Health Plans
By Spencer Smith
It’s time to put your thinking cap on…Should you build commission into your employer’s stop loss premium or work off a direct consulting fee? That’s for you to answer, not me, but here is the math…
“Charges at existing physician-owned hospitals for eight common procedures were one-third lower than what a traditional hospital charged in the same markets…..”Continue reading End Restrictions On Physician Owned Hospitals To Expand Quality Care
“Raw, rude, and a rejection of everything……………completely different operating philosophy……………………an innovation shock…………… nothing was sacred”Continue reading Only Sex Pistols Can Solve Healthcare
By Sarah Owermohle Aug. 8, 2023
WASHINGTON — A bipartisan group of senators wants federal tax regulators to probe nonprofit hospitals’ compliance with community benefit requirements, ratcheting up a longtime campaign to hold the tax-exempt providers accountable.Continue reading Senators Push IRS To Launch Nonprofit Hospital Probe
Over 100,000 physicians quit healthcare in one year alone — 2021 — and this exodus is continuing………………….Continue reading Over 100,000 Doctors Quit Health Care In 2021
The Vital Role of Crop Insurance: Protecting Farmers, Ensuring Food Security, and Strengthening Rural EconomiesContinue reading Agriculture Risk Management
Somehow, hospitals and insurers continue to get away with only providing estimates and not actual prices for their services and procedures. This allows our healthcare system to remain rigged for their profit and to the detriment and demise of patients, families, communities, tax payers, unions, employers, and municipalities across the country.Continue reading A World Without Prices
Fentanyl is a synthetic opioid far more powerful than morphine, and it has been blamed for about 70,000 overdose deaths per year in the United States. Mexican cartels produce it from precursor chemical smuggled in from China, and then often press it into pills designed to look like other medications.Continue reading Mexican Counterfeit Medication May “Contain Deadly Doses of Fentanyl”
Ron Barshop on Linkedin
State of Texas HHS has a wall with a chart 3-4x more complex than this. It was impossible plumbing to comprehend. I asked 20 years ago of a state health care leader there “does anyone here understand all this ?” He smiled in that big Texas way and just looked down chuckling. ACA btw has likely added way more boxes, triangles, ovals and pipes.Continue reading This Is What Happens When Gov’t Interferes With Health Care Delivery
“It’s probably the worst period for auto insurers in 30 years at least”Continue reading What’s Driving Auto Insurance Premium Hikes?
“Earth to employers/employees – BUCA networks permit 1,000% pricing variation for the same care in the same city in the same network. PHCS permits over 2,000% pricing variation. 80% of you don’t meet your deductible so you are paying out-of-pocket cash for all care.”Continue reading The Tail Is Wagging The Dog
Sunday Morning Bathroom Read (“Nope” Edition Part I/And yes, it is a two part series):Continue reading Aldeen’s Sunday Morning Bathroom Read – Nope Edition, Part 1
Hiding fees in claims is a long practiced tradition in American health care finance. Just about everyone seems to be in on the take.Continue reading Quit Hiding Your Fees In The Fixed Costs!
Willy the Texas rodeo goat, on the lam for weeks, has been found safe
HOUSTON (AP) — Willy the rodeo goat, who has lassoed the hearts of residents in a rural South Texas county ever since she escaped from an arena enclosure July 15, has been found.Continue reading Famous So. Texas Rodeo Goat Brings Community Together
The Legal Cavalry Has Arrived
The “worst” result Health Rosetta team has driven is a 20% absolute reduction in per capita spending while health plans/outcomes dramatically improved. The secret behind that has been Health Rosetta’s largest investment — assembling the Dream Team of attorneys who have leveled the contractual playing field.Continue reading Healthcareistan
Connecting Health Plans with the Largest Cash Pay MarketplaceContinue reading Cash Pay Provider Network
The UT System’s decision comes after Ascension, a St. Louis-based health system with 139,000 employees, made the same decision to no longer cover weight loss drugs under its employee health plan.Continue reading University of Texas Dropping Weight Loss Drug Coverage
Adderall Shortage Has US Agencies Urging Drugmakers to Boost Output
Story by Ike Swetlitz • Yesterday 4:56 PM
(Bloomberg) — US drug regulators and law enforcement officials asked pharmaceutical companies to manufacture more Adderall, an ADHD medication that has been in short supply for nearly a year.Continue reading Biden Administration Wants More Adderall For Attention Deficit Americans
By Bryce Heinbaugh on LinkedIn
All we needed to see was proof other large employers are courageously putting a stop to covering these drugs for weight loss as it is unsustainable.
Actuaries advising us to prepare our clients for as high as 15% increases in claims costs next year because of these weight loss drugs, especially to our struggling public entity clients like schools and municipalities who are facing layoffs and further cuts.Continue reading Employers Cut Off Access to Weight-Loss Drugs for Workers
Hello hard working brokers!
In my continued effort to educate and inform, here is more information about what employers are doing (fighting) for data that shows how their health plans overpay for care. Please click on this Bloomberg news report released today to learn more.Continue reading Employers Are Fighting For Their Healthcare Data
“Agencies have level-funded plans on their radar and may soon seek to define and regulate them differently than traditional self-funded plans.”Continue reading Faceless Government Bureaucrats Eye Regulation of Level Funded Plans