Archive for the ‘Uncategorized’ Category

Medicaid Life Settlements

Saturday, May 18th, 2013

If one of your elderly clients was about to enter a nursing home, probably the last piece of advice you’d give them would be to surrender their life insurance.

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Delta Dental & Greed

Friday, May 17th, 2013

pruitt     By Darrell Pruitt, DDS – darrelldk@tx.rr.com

Delta Dental and other discount dentistry brokers in Iowa attempted to limit preferred providers’ fees even for work even after Delta patients exceed their annual maximum. Of course, it’s Delta which sets the annual maximum. The free market won. Delta tyranny was defeated… this time.

“Court sides with Iowa dentists in key billing case” By RYAN J. FOLEY, Associated Press

http://www.chron.com/news/article/Iowa-court-to-decide-key-case-for-dental-billing-4524864.php

The “Burden” Of High Deductibles

Friday, May 17th, 2013

The “burden” of high deductibles is really not a burden at all compared to what you pay for a lower deductible, month after month, year after year.

Bronze Plan Premium Gold Plan Premium Difference Maximum Bronze Deductible
Individual 2,700 4,680 1,980 1,750
Family 9,526 16,716 7,190 3,500

So families with “high deductibles” of $3,500 or less are “burdened” even though they would have to pay $7,190 in higher premiums to avoid the deductible. Keep in mind that the premium is lost money.

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Ordinance Requires $1Million “Dangerous Dog” Policy

Thursday, May 16th, 2013

dog

More government insurance mandates? Times have never been so good for insurance brokers.

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Balance Billing, Chargemaster Pricing & Remedies

Wednesday, May 15th, 2013

 

Balance Billing

“We guarantee zero balance billing to our clients as part of our comprehensive medical claim administration services, guaranteeing that patients will never be hassled by a provider for additional funds.”

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Hospitals Dismiss Significance Of Chargemaster Prices?

Tuesday, May 14th, 2013

lustig Victor Lustig

By William Rusteberg

Hospitals dismiss the significance of chargemaster prices? (See link to article below). That is totally misleading. Chargemaster prices are extremely significant and gives rise to a billion dollar business for intermediaries such as insurance companies, audit firms, law firms, claim re-pricers, and third party administrators.

The scheme is tied up in “savings” to be realized through the difference between arbitrary and unreasonable chargemaster prices and what is actually paid. The quantative differential  can be enormous.

Percentage of savings fees is the greatest fraud foisted upon consumers since Vicor Lustig sold the Eiffel Tower in 1925.

It is clear to all that chargemaster rates are “totally around the bends.” No one will disagree with that. Yet many ancillary industries, given rise by our current health care delivery system including managed care companies, audit firms and third party administrators depend on chargemaster pricing without which they could not survive.

If the average differential between chargemaster pricing and the actual price paid is 50-80%, there is a lot of “money” contained in the “spread” to be earned. Many PPO networks, for example, will charge 30% of savings for out-of-network claims. 30% of 80% is 24%. To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.

A well oiled conspiracy requires sharing.  Commonly formed side-agreements are forged between willing partners. Health care intermediaries are in a competitive business.

Thus, hospital chargemasters have fueled the fortunes of many health care intermediaries and the scheme continues…………………………

http://www.fiercehealthfinance.com/story/hospitals-dismiss-significance-chargemaster-prices/2013-02-25

Editor’s Note: See previous posting: http://blog.riskmanagers.us/?p=11495

Insurers Predict 100-400% Obamacare Rate Explosion

Monday, May 13th, 2013

atomic bombhttp://washingtonexaminer.com/insurers-predict-100-400-obamacare-rate-explosion/article/2529523

HealthSmart Continues Acquisition Strategy – 8 TPA’s in 2 Years

Monday, May 13th, 2013
“During the past two years, HealthSmart has acquired seven other third party administrators,” said Daniel D. Crowley, Chairman of HealthSmart.

Medicare Releases Rx Records

Sunday, May 12th, 2013

Medicare’s popular prescription-drug program now serves more than 35 million people, but the names of prescribers and the drugs they choose have never previously been public. Use this tool to find and compare doctors and other top prescribers in 2010.

http://projects.propublica.org/checkup/

Cost Plus Dental

Saturday, May 11th, 2013

The Cost Plus Dental model is very simple.  Like Costco or Sam’s Club, patients pay an annual membership fee.  Cost Plus Dental uses these membership fees to help offset the cost of care which allows members to have high quality care for extremely low cost.  In addition, care can be provided without the limits and restrictions associated with traditional dental benefits plans.

https://costplusdental.com/Home_Page.html