“I’ve spent the better part of three decades dissecting the American health insurance racket from every angle — as an attorney, as strategist, and as someone paid to clean up the mess insurers leave behind. I’ve seen it all.” – Craig Gottwals
Continue reading Confessions from the Belly of the Beast
“Traditional TPA centered health plans, inefficient and expensive, are becoming outdated faster than a you can say ‘What Happened?’
“Payer platforms are emerging………….such as the partnership between Mishe Health and Mark Cuban’s Cost Plus Wellness, which allows real-time adjudication, flexible benefit design, same-day provider payments, and transparent contract management.”
Continue reading Employer-Provider Direct Contracting: Practice And Policy
“Forget the discount, forget the billed charge, we gonna pay you what we know you’ve accepted in the past. And we ain’t gonna pay no more stinking PPO access fees either!” – Molly Mulebriar
Continue reading TALON’s Universally Acceptable Payment Amount ™
By Craig Gottwals
“This is why telling employers they don’t need the legal muscle and case law precedent of Reference-Based Pricing (RBP) is like saying we can ditch the Highway Patrol — because hey, speed limits are posted now!”
Continue reading We Don’t Need The Highway Patrol Anymore Because Speed Limits Are Posted
By Dutch Rojas
After we sold Sano Surgery in the fall of 2022, I spoke with more than two hundred independent practices, including orthopedic groups, surgical centers, and a few physician-owned hospitals.
Each one had its own rhythm, with different EMRs, benefit plans, and ways of operating.
But they all had one thing in common: not a single one was working with other practices to coordinate their property and casualty insurance.
Continue reading Offshore Rx Importation Exempt From Trump Tariffs
ScriptSourcing is pleased to share that pharmaceuticals and personal importation are exempt from tariffs. This decision allows us to continue supporting our clients in reducing prescription drug costs, which is crucial for improving healthcare accessibility. The exemption ensures that plan members can access essential maintenance medications with a $0 copay, significantly enhancing affordability and health outcomes.
Sincerely,
The ScriptSourcing Team
A True Story
“I want to go to MD Anderson!” says Mary. “But they won’t take our insurance!”
Continue reading I Want To Go To MD Anderson!