Month: February 2024

Doctors who accept health insurance forfeit more than half their pay to do so through labor costs and fixed cost overhead.

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Edinburg Independent School District’s insurance consultant discusses international sourcing of prescription drugs as a cost effective option to high cost American specialty drugs.

The newer generation of people you’re trying to recruit and retain want more choices and more say in selecting the benefits that fit them best.

Don’t roll over, fight when you think you’re right………..

“Sutter left Donovan with no other option. Thus, in early December, Donovan filed her claim in Superior Court of California for Alameda County: Leslie H Donovan v. Sutter Health Billing Department.”

Taking a job as a door-to-door salesman for Combined Insurance the slick-talking salesman was a natural. He broke a company record by selling 271 policies in one week.

Double Indemnity is a 1944 thriller. It stars Barbara Stanwyck as a housewife who is accused of killing her husband for insurance money and a claims adjuster whose job is to investigate.

“I’m at a healthcare conference. Was talking to a presenter this morning about our health plan. He said we are progressive, so much so even most of the consultants here are behind us. A nice testament to the excellent work you did for us.”

THE PROBLEM

Competing for hourly workers is tough business. It’s a price war. Employees leave at the drop of a hat, chasing nickels and dimes, flipping burgers right down the street in plain view instead of serving your customers at a dime an hour less.

TX Drivers :You may be eligible to receive a massive discount on your insurance. New rules greatly favor those who drive less than 50 miles/day, and insurers are scrambling as drivers learn about this. Those who live in qualified zip codes can get even larger discounts.

By Guy Culpepper MD

The supply of family physicians cannot be raised or lowered based upon yearly market fluctuations. 

Name Redacted At Request Of Family

A prestigious cardiologist died last week and was given an elaborate funeral by the hospital he had worked for most of his life.

If you are a Public Organization with a self-funded plan it is expected you will be part of the 46% total expenditures of prescription public cost in 2024! The chart above shows changes in absolute spending, by payer.

At the end of the Mexico-Tenochtitlan Conquest, Hernán Cortés began the construction of the hospital known as “El de la limpia Concepción de Nuestra Señora,” at the place where he had first met Moctezuma.

Blue Cross agent bonus program is limited to a measly $500,000. Aetna competes for the same brokers by offering an unlimited bonus program. Now we see United Healthcare matching Aetna’s unlimited bonus program with a program of their own.

Blue Cross pays brokers a “Loyalty Bonus” of up to $500,000. Now we see Aetna competing for brokers with what appears to be an unlimited “Loyalty Bonus.”

By Julie Selesnick, Attorney

Seriously, all the handwringing over how complex our healthcare system is and why cost containment is so difficult is silly—the answers are pretty obvious. Here is reason Number #1: The #BUCA billions—this is what we are overpaying for—the billions raked in annually by UnitedHealth, CVS, Elevance, Cigna, Centene & all the other major carriers & PBMs.

Paying health insurance claims is more than just paying providers. You’ve got to pay a whole lot of other people first and it’s adding up fast.

The plan spent $102M on the weight-loss drugs last year, 10% of total drug costs.

“What brings you in today?” asks the admissions clerk. “What brings you in today asks the nurse?”

In response to a previous blog posting (SEE POSTING HERE) we received an email from a primary care physician we know asking if insurance sales was an opportunity for him and “if so, how?”

“By Golly!” I thought, “He’s on to something!”

BCBSTX announces 2024 bonus program for individual and group sales……..

This bonus program is in addition to (and separate from) all other BCBSTX bonus programs. The maximum payout per contracted producer or agency is $500,000 per participating plan state.

Newly minted dentist treats his first patient who is in immense pain.

Be aware whatever you tell your insurance company can be weaponized against you faster than a speeding bullet by armed politicians working against your vested interests.

Ozempic, Mounjaro makers hit with ‘stomach paralysis’ lawsuit

Stomachs remain full of days-old rotting food, which is unusual because less than 10% of food consumed is left in the stomach four hours after a meal

The UNITED STATES and some other countries require a prescription on all medications sold from Mexico. They further require documentation in English and an invoice of all medicines sold for customs.  For these countries, Medicina Mexico is now delivering your medicines to Dr. Isaac Reyes, MD (Ced. Federal 644884) (Ced. Estatal 1537-02/05) along with the required documentation including documentation on each medication sold in English is from Wolters Kluwer.

Health insurers mark up prices of generics for cancer, multiple sclerosis and other complicated diseases

By Armando Polanco

Great read below on who sets the prices on prescriptions in the United States

My first job was tossing coal into the fire at a steel mill in Pittsburgh, Pennsylvania. I worked hard and thought that, by being the most productive on the floor, it would create an opportunity to advance in the company.

Ever wonder what goes on behind the scenes of a pre-certification program wherein medical procedures are considered for approval?

Texans for Excellence in Education (TEE) and its partner, Insurance One, are in a “full court press” getting their insurance portfolio comprising 49 ISDs ready for the international market for the 2024-2025 school year.

Mission State Farm insurance agent celebrates 50 years

Jerry thus began his insurance career in 1974, his first office four blocks from the agency’s current location, where Sweets by Kacy sits. He and his wife furnished the building with two lawn chairs and a chestnut-colored desk and got to work.

ICHRA Insurance brokerage works on commission only and does not charge fees to access their platform unlike other ICHRA vendors who charge as much as $30-$40 PEPM administration fees + commissions.

Below are a few slides of interest for today’s today’s TRS ActiveCare board meeting:

By Paul Miller

It’s said that insurance cost Quentin Tarantino an Academy Award.

Public school educators moonlighting as medical diagnosticians are on track to save expecting parents across the country millions of dollars in sonogram and ultrasound testing services.

See how DPC physicians described their practices HERE.

The following represents an offer to provide certain actuary services to self-funded health & welfare plans:

The original RFP document said the state wanted bidders to show they could keep reimbursement levels below the current mark of 245% of Medicare rates, and as close as possible to 195%.

Over the years we have seen numerous lawsuits brought against BCBS of Minnesota. To our knowledge none have gone to trial. This one will probably settle too in order to staunch further embarrassment.

By Paul Miller, London

Did you know that Lloyd’s of London helped Mickey Mouse celebrate his 8th birthday?

More Louisiana officials are voicing opposition to the planned sale of Blue Cross Blue Shield of Louisiana to Elevance Health. 

To see a traditional fee-for-service doctor these days you may have to wait 1 month for an appointment or longer, and then wait an hour or more while sitting in the reception area along with sneezing, drooling, belching, coughing patients in order to see the doctor for 5, or if you’re lucky, 10 minutes.

A better benefit design, built by Harbor Health

Later this year, Texas-based employers will be able to choose our all-new benefit design created to help self-funded groups eliminate cost barriers along the consumer health journey.  

Want proof a 20% PPO discount off arbitrary billed charges is meaningless? Read on…..

“When it suited them, they could be a private nonprofit……….When it didn’t suit them, they could jump back into being a government entity — although there was no government involved.”

The San Antonio Independent School District (SAISD) requests interested parties to submit proposals for “Employee Benefits Consulting Services”. This award is contingent upon funding and no guarantee of a minimum amount of work is implied or expressed by this Request for Proposals. Services required shall be determined solely by the needs of the District.

San Antonio Independent School District – 24-006 (LC) Employee Benefits Consulting Services

Article Referred By Doug Aldeen Which Somehow Has Something To Do With The American Healthcare Delivery System (although we don’t know what)

On April 5, 1996, this Court ordered Plaintiff to show cause why this Court should not impose Rule 11 sanctions upon him for filing a motion for improper purposes. The motion which Plaintiff filed was entitled “Motion to Kiss My Ass” (Doc. 107) in which he moved “all Americans at large and one corrupt Judge Smith [to] kiss my got [sic] damn ass………………………..”

Mr. Lamendola, as the Company’s largest shareholder, has committed to investing at least $3 million in equity during 2024.

Jelly Roll, Lainey Wilson, Valerie June Demand Healthcare Reforms: ‘Hospitals and Insurers Are Robbing Us’

The three artists called for pricing transparency in a PSA from Power to the Patients set to air during Super Bowl LVIII

Green Imaging has been wildly successful in buying capacity for resale in the health care world of American health care finance.

We are not picking on TSHBP – their program is not much different than any other employer sponsored plan of the past 40 years.

By Mike Scarcella

The lawsuits alleged a conspiracy among Blue Cross and its members to curb competition, driving up the cost of insurance and driving down reimbursements.

More plan sponsors are saying ENOUGH IS ENOUGH ALREADY! Eliminating brand name and specialty drugs completely, leaving over 12,000 FDA approved generic drugs is an option more plans are considering.

“It was rough in the beginning because we all get this programmed in our head that magic insurance is gonna pay for everything and we have no responsibility…..”

Hidalgo County is seeking competitive proposals for Insurance Consultant for their self-funded BUCA plan.

Article Referred By Alex Zuniga (One of our three readers)

A healthcare provider that recently left the South Texas market has failed to stem losses and is filing for bankruptcy.

“How Much Do You Charge?” asks the prospect, a large public school district spending $50,000,000 on their self-funded health plan………………

No one willing to comment on whether the program still exists………..

By Julie Selesnick, Senior Counsel at Berger Montague

Seriously, all the handwringing over how complex our healthcare system is and why cost containment is so difficult is silly—the answers are pretty obvious.

By Kevin Weinstein – Chief Executive Officer at Renalogic

February 6, 2024

If you haven’t already, everyone involved with employer-sponsored healthcare should read and understand this lawsuit (Lewandowski v. Johnson and Johnson) filed by an employee against Johnson & Johnson’s health plan.  The key allegation is that the J&J health plan failed in its fiduciary responsibility to design and oversee a health plan that benefits members and pays reasonable rates for services. 

Archie admits himself to the hospital for his operation when he has a run-in with one of the nurses.

“Here it is folks, the case everyone has been waiting for: an employer has been sued for breaches of their fiduciary duty under ERISA by a plan participant for the drug costs in their self-funded health plan.“

US Beacon (USB) conducts compliance analysis review of medical claims for corporate and government health care and workers compensation plans.

By Russell Pekala

Setup: Providers (red) make a choice “Play nice” or “Play dirty” represented by the left and right columns and receive RED payouts. Payers make the same choice represented by the top and bottom rows and receive BLACK payouts

Johnny Dollar, America’s fabulous freelance insurance investigator, investigates a murder involving a beautiful widow in a negligee……………..

By Ge Bai – The Curious Case Of ‘Free’ Covid-19 Tests

Starting from November 20^th, 2023, every household in the U.S. can order eight “free” at-home Covid-19 tests (four for those that already ordered this fall). How much taxpayers paid for these tests remains undisclosed.

By Doug Aldeen

The Great Aldeeni is on to something! – Open an Aldeen Miracle Grow Bank Account today and receive a bag of carrots and a free trip to Disney Land! – The H&R Block of IRC 501r? Take it public – The IPO has got to be a record breaker – Will the Great Aldeeni offer franchise opportunities? Count me in………..

“I would set up a booth in every grocery store across the US (much like H&R Block and its ubiquitous “tax refund” stands) and charge a flat fee to process the charity care application……….. “Honey, make sure to pick up a loaf of bread and while you are it, get our charity care application submitted. We should get back enough to take the entire family to Disney this year.” – Doug Aldeen

!If you’re getting ready to turn 65 but you’re on your spouse’s health insurance because he or she is still working, should you stay on his employer healthcare plan or get on Medicare?

Texas Education Agency takes over La Joya ISD after investigating school board for fraud and conflicts of interest…………..