Archive for the ‘Uncategorized’ Category

How Dare You! 177% of Medicare Is Insulting!

Sunday, February 17th, 2019

The state of North Carolina has adopted Reference Based Pricing for their state employee benefit program to become effective in 2020. The reference price will be pegged at 177% of Medicare. That has caused an uproar with the state’s hospitals and they are fighting back hard.

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McAllen ISD To Interview Top 3 Consultant Finalists

Sunday, February 17th, 2019

By Molly Mulebriar

McAllen Independent School District in deep South Texas is set to interview the top three finalist for the district’s insurance consultant position this week. MISD employee benefit program is self-insured and administered by Blue Cross & Blue Shield.

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Texas Medical Association Highlights Reference Based Pricing

Saturday, February 16th, 2019

“It’s an intriguing way to lower costs for both physicians and health plans, and it could reduce premiums for patients. It also could enable doctors to wrestle more contract-negotiating leverage out of the hands of the market’s dominant health plans ― and in some cases, contracting with them might not even be necessary.”

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American Health Care – The Economic Trojan Horse of Destruction

Saturday, February 16th, 2019

“We are taking that wasted money and artificially inflating the cost of health care to the point that nobody can afford it without government continuing the death spiral of spending, monopolizing, and price inflation.”

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Reference Based Pricing

Thursday, February 14th, 2019

In this video, Dr. Eric Bricker Explains Reference-Based Pricing.

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Reasons For Having A Primary Care Physician

Thursday, February 14th, 2019

Dr. Eric Bricker Explains 3 Reasons for Having a PCP: 1) Screening, 2) Same-Day / Next-Day Appointments and 3) After-Hours Call-In Access.

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Why Aren’t More Employers Implementing Reference-Based Pricing Benefit Design?

Tuesday, February 12th, 2019

In contrast to deductibles, where the patient pays the “first dollar” of medical expenses, under RBP, the patient is responsible for the “last dollar.”

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The Great Free Standing ER Scam Continues…………………

Tuesday, February 12th, 2019

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Catholic Diocese Insured Against Child Sexual Abuse Claims

Monday, February 11th, 2019

Liberty Mutual has agreed to pay the Diocese of Duluth US$6.5 million under a recent settlement agreement over litigation of insurance coverage for child sexual abuse damages………..

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Greenlight Re invests in Texas-based TPA

Sunday, February 10th, 2019

Greenlight Re Innovations, part of specialist property and casualty insurer Greenlight Capital Re, has announced an investment in Sana Benefits, a Texas-based third-party administrator (TPA) focused on the self-insured health market……………...

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$1,000,000,000.00 Insurance Scam

Sunday, February 10th, 2019

Four men and seven companies have been charged in connection with a $1 billion healthcare scam, according to the Department of Justice………………….

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AccuRisk Solutions LLC

Sunday, February 10th, 2019

AccuRisk Solutions LLC is a Chicago-based Managing General Underwriter focused on providing its producers with innovative insurance products and outstanding customer service.

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Mexican Drug Run

Sunday, February 10th, 2019

“It’s cheaper for us to pay for the drug down there, send them down there and then give them $500….”

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Japan Post Eyes $2.6 Billion Investment in AFLAC

Sunday, February 10th, 2019

Japan Post would like to expand Aflac’s cancer insurance products sold at post office counters…..

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Kratom Anyone?

Friday, February 8th, 2019

Kratom is a miracle cure for everything from opioid addiction to anxiety……..

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Nataline Could Have Been 28 Today If Not For A Health Insurance Decision

Friday, February 8th, 2019

I’ve been asked many times if there was one thing, one moment, that led me to leave my job at a big health insurance corporation. Yes, there was, and it occurred five days before Christmas in 2007. That was when a beautiful 17-year-old girl named Nataline Sarkisyan passed away, days after the company I worked for refused to pay for a liver transplant that her doctors believed would save her life. A few days after Nataline’s death, I turned in my notice.

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Climate Change & Employee Benefits – Are You Kidding Me!

Friday, February 8th, 2019

If your’re in HR and believe in climate change this article is for you. You may want to consider offering your employees energy-free light bulbs and mandate car pooling………….

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Insurance Denials Can Be Death Sentences

Friday, February 8th, 2019

                  Molly Fetzer

Self-funded school district overrides TPA’s (Anthem) decision to deny coverage and authorizes doctor ordered treatment plan for stage 4 cancer member………………….

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Patient Sentenced To Death?

Thursday, February 7th, 2019

Putting dollars in front of saving lives……………………..?

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Sheryl Bonner 1963-2019

Wednesday, February 6th, 2019

Respected industry leader passes………………………

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Why Employers Should Work With Older Folks

Wednesday, February 6th, 2019

“I’m 67, so I could give a shit,” she says. “What are they going to do, fire me? I’m packin’ a Medicare card.” – Marilyn Bartlett

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USA Rx Revolt Looks To Canada For Help

Tuesday, February 5th, 2019

Colorado on Thursday joined a growing number of states that want to cut certain prescription drug prices by importing licensed drugs from Canada………………..

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Gotta Love Bernie!

Tuesday, February 5th, 2019

Bernie Discovers Self At Early Age

Senator Sanders asks why drug, once free, now costs $375,000,000.00…………..

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HRA’s To The Rescue!

Tuesday, February 5th, 2019

The HRA’s Are Coming!

Expands the use of HRAs to allow for the purchase of individual health insurance coverage…..

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Centenarians Rejoice

Monday, February 4th, 2019

Hawaii considers ban on cigarette sales except for centenarians…………………..

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Cigna’s $54 Billion Problem

Sunday, February 3rd, 2019

Health insurer’s purchase of Express Scripts is looking like even more of a blunder……..

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The Prevalence of Self-Funded Health & Welfare Plans

Sunday, February 3rd, 2019

With steady growth in the last four decades, self-funded plans are now the most common type of health plan that workers are enrolled in across the United States. Various sources put this number at nearly 70% and climbing. Nearly all self-funded employee benefit plans are managed through a third party administrator (TPA) firm, an independent organization that assists with overall plan operations, benefit coordination and claims processing.

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Nonprofit Dental Insurer Under Scrutiny For ‘Flagrant’ Spending

Thursday, January 31st, 2019

Dental insurance giant Delta Dental of California is facing mounting criticism for paying its CEO exorbitantly, flying board members and their companions to Barbados for a meeting……

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Wednesday, January 30th, 2019

Man Robs Bank, Demands To Be Sent To Prison

Wednesday, January 30th, 2019

“I’ve never heard anyone rob a bank so they can get to prison so they could get health care,” James Griffin, the assistant district attorney prosecuting Gallagher……………..

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Solution To High Health Costs: Abolish Health Insurance!

Wednesday, January 30th, 2019

Health Insurance Agent Reacts to News

Raging Left Coast Democrat vows to eliminate all private health care insurance for approximately 150 million Americans………………………………….

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A Cure For Cancer?

Tuesday, January 29th, 2019

A small team of Israeli scientists think they might have found the first complete cure for cancer…….

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Brownsville ISD Seeks Insurance Consultant

Tuesday, January 29th, 2019

The Brownsville Independent School District (BISD) in deep South Texas is seeking an insurance consultant in a competitive request for proposal process.

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Medical Industrial Complex Fights Back

Tuesday, January 29th, 2019

A new group wants to raise $2.5 million to fight State Treasurer Dale Folwell’s plan to reduce health care spending for about 720,000 state employees and retirees…………….

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School Superintendent Accused of Insurance Fraud

Tuesday, January 29th, 2019

Superintendent used her own health insurance to seek medical treatment for a sick student…….

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Spectrum Equity Leads Majority Recapitalization of Payer Compass

Sunday, January 27th, 2019

Investment positions Payer Compass to continue its rapid growth………to date the company has grown to serve over 125 payer customers, representing nearly 1,000 employer groups and over two million covered lives………………….

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On Fire!

Friday, January 25th, 2019

We were excited to be featured on the CBS Evening News and CBS This Morning earlier this week!

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Health Insurers Support Single Payer System?

Thursday, January 24th, 2019

As the support for a single-payer, “Medicare-for-All” health care system in U.S. grows, so do the contributions from the health insurance industry………………

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Americans Mad As Hell About Cost of Health Care

Wednesday, January 23rd, 2019

Poll: 56 percent of public supports ‘Medicare for all’

BY PETER SULLIVAN – 01/23/19

A majority of the public supports a single-payer health insurance system, often called “Medicare for all,” as the idea gains steam among Democrats, according to a new poll.

The poll from the Kaiser Family Foundation finds that 56 percent of the public supports a single-payer plan, compared to 42 percent who oppose the idea.

Progressives are pushing the new Democratic House majority to move forward on the idea, and many Democratic presidential hopefuls have signed on to the idea as well. More centrist Democratic lawmakers remain opposed to the proposal, however.

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What’s Your RBP Sweet Spot?

Monday, January 21st, 2019

The State of North Carolina’s Reference Based Pricing sweet spot is 177% of Medicare. “The new rates for various categories of services will average out to 177% of Medicare’s fees, down from a current (PPO) average of 213%, North Carolina Treasurer Dale Folwell (R) told The Wall Street Journal. …………………………”

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Another Vendor Enters Reference Based Pricing Marketplace

Sunday, January 20th, 2019

Another vendor, touting a NEW strategy to reduce health care costs, enters the Reference Based Pricing arena. They, along with the rest of their competitors are 35 years late in identifying the concept. Back in the early 1980’s J Patrick Rooney (1927 – 2008) contended that authoritative research showed that Medicare plus 25 percent is the reasonable amount for hospitals to charge. Then, of course, there is J.P.Farley (www.jpfarley.com)who has actually been implementing Reference Based Pricing plans since the 1990’s……………………….

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The Only Way to Pay Less for Health Care Is to Pay Less for Health Care

Friday, January 18th, 2019

This 35 minute podcast is well worth the time………….Listen to the Master, David Contorno…..

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Wellness Programs Expected To Hit New Highs

Friday, January 18th, 2019

Wellness Consultants Cheech & Chong

Attention HR Directors! Take your Wellness Program to a high & reap the rewards of a happy and mellow workforce! 

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Health Insurance Brokers Identify Key Cost Drivers?

Thursday, January 17th, 2019

“Brokers are also seeing high demand for benefits communication, employee engagement and transparency as a way to address the rising cost of healthcare…..” REALLY? How in the world will this reduce health care costs?

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Are Rising Drug Cost Destroying Group Health Plans?

Thursday, January 17th, 2019

“The primary villain in the multi-year erosion of the value of the employer-provided health benefit, and private insurance generally, has been drug costs.”

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Court Case Addresses Cross-Plan Offsetting

Thursday, January 17th, 2019

“The court strongly hinted that the practice violated ERISA’s fiduciary duty rules, including the requirement that plan assets of one plan be used for the ‘exclusive purpose’ of benefiting individuals covered by that plan.”

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Texas Teachers Giveth Raises – Health Insurance Taketh Away…………

Thursday, January 17th, 2019

A RETIRED TEXAS SUPERINTENDENT ON WHY TEACHERS ARE QUITTING IN DROVES: “UPS starts people with no experience (HS diploma or GED) at $13 per hour plus full benefits. Within a couple of years you can graduate to a route where drivers make six figures after five years. In 7 years you can make over $100k delivering packages. In contrast, my wife is in her 25th year as a teacher with a Masters degree. She makes $57k and has some of the worst insurance in the country”

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What Can We Do About The Cost Of Health Care?

Wednesday, January 16th, 2019

Answer: Pay Less For Health Care………………………………..

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RBP Vendor Fees In An Evolving Competitive Market

Wednesday, January 16th, 2019

As Reference Based Pricing (RBP) strategies take hold in the market, with more vendors entering the fray for market share, the inevitability of increasing competition becomes evident. That is good news for plan sponsors……………………

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PBM Consultants Know More Than General Benefits Consultants

Wednesday, January 16th, 2019

 

 

“Find help from experts—do not use a general benefits consultant—this is tricky stuff!” That is a true statement. Most general benefits consultants don’t know squat about the PBM world and simply make recommendations off spreadsheets. “This one is the best because they are offering AWP-28%!”

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Health Care’s Most Needed Next Step

Tuesday, January 15th, 2019

January 14, 2019

By Brian Klepper

It seems inevitable that, in the near future, an innovative health care organization is going to seize the market opportunity, gradually cobble all the pieces together, and demonstrate to organizational purchasers that it consistently delivers better health outcomes at significantly lower cost than has previously been available.

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Oversight Committee Launches Sweeping Drug Price Investigation

Tuesday, January 15th, 2019

“The goals of this investigation are to determine why drug companies are increasing prices so dramatically, how drug companies are using the proceeds, and what steps can be taken to reduce prescription drug prices.”

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Public Entities Address Rising Retiree Health Insurance Costs

Monday, January 14th, 2019

The following article can be summed up as follows: Changing from a Defined Benefit Plan to a Defined Contribution Plan saves money…………………….

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Robbing Peter To Pay Paul

Monday, January 14th, 2019

The majority of recoupments are taken at the expense of self-insured plans to the benefit of fully-insured plans………………..

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Hospital Transparency? Good Luck

Monday, January 14th, 2019

“There is “sobering evidence” that the level of price transparency is actually getting worse…….

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No Benefit Waiting Periods for All Americans!

Sunday, January 13th, 2019

Most group health insurance plans have a 30, 60, or 90 waiting period before coverage starts. We know of one that has an even longer waiting period…………..

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Is Health Care A Right or A Commodity?

Saturday, January 12th, 2019

The master of reason and logic explains……………………..

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This Week’s Savings Shenanigan Story……

Friday, January 11th, 2019

It pays to shop for health care. A $40,000 drug for 1/10th of that……………..This broker is worth her weight in gold. Is yours?

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Want To Know The Price? Go Fuck Yourself!

Friday, January 11th, 2019

WELCOME TO OUR MODERN HOSPITAL WHERE IF YOU WANT TO KNOW A PRICE YOU CAN GO FUCK YOURSELF……………………………….

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Proposed Expansion of HRA’s A Game Changer

Thursday, January 10th, 2019

Employers of any size may offer HRAs to reimburse employees for the cost of their premiums for individual health insurance coverage…………….

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North Carolina’s Brewing Battle Over Health Care Value

Thursday, January 10th, 2019

“We’ve got 9 million taxpayers and 720,000 participants in this plan who understand that they aren’t consuming health care, it’s consuming them.” — Dale Folwell, N.C. Treasurer

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Payer Compass Success Was Inevitable……………

Tuesday, January 8th, 2019

Karmac The Magnificent predicted the eventual emergence of a more competitive market with multiple vendors competing for business. Now we see a growing and dynamic market with more competition, lower costs and many vendors. And the market leader appears to be Payer Compass……………..

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School District Fails To Address Rising Health Care Costs?

Tuesday, January 8th, 2019

Houston Independent School District is in financial hot water. There are many reasons for this. One is the Robin Hood effect wherein HISD must transfer local taxpayer money to the state for re-distribution to poorer school districts. Another is the rising cost of health care, Houston ISD’s second largest budget item. 

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You Want How Much!

Monday, January 7th, 2019

Medical providers can charge whatever they want. Heretofore no one cared. Until now…..

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Rural Texas Hospital Defies The Odds

Monday, January 7th, 2019

This story also reflects some of the challenges faced by rural hospitals everywhere……………

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Is Payer Compass The # 1 Reference Based Pricing Vendor?

Sunday, January 6th, 2019

“We are extremely proud of the success Payer Compass has achieved to date as we have grown the company to serve over 125 payer customers, representing nearly 1,000 employer groups and over two million covered lives.”  –  Greg Everett

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How Do You Measure Savings?

Thursday, January 3rd, 2019

Question: How do we know we are doing better (saving money) this year than last year?

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Why Are Employers Embracing Reference Based Pricing Plans?

Thursday, January 3rd, 2019

They are running out of money…………………………………

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Primary Care Is An Investment – The Rest of Health Care Is A Payment

Thursday, January 3rd, 2019

The end objective is a better health care delivery model with an alignment of “enlightened self-interests” and a balance between rewards and value for the employer, employee, and provider……..

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Tuesday, January 1st, 2019

Confessions of a Reformed Health Insurance Broker – From Innocence To Darkness

Slowly we saw the rise of third party administrators, the evil purveyors of self-funded employee health & welfare plans…..

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Christus Health Publishes Something

Tuesday, January 1st, 2019

Oh, this makes sense! Everyone knows what 1100000003 is. Last time I had a 1100000003 was last year and my insurance paid only $1,654 for almost a 50% discount. Oh-My-Gosh, 1100000027 looks really competitive………! I’m going to Christus Health next time!

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Worshiping the False Idols of Wellness

Sunday, December 30th, 2018

Before we go further, I’d like to clear something up: Wellness is not the same as medicine…….

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Texas School District Set To Close 12 Schools

Sunday, December 30th, 2018

Austin school district officials are proposing closing 12 schools, among other cost savings that total $55.1 million, as the district faces a deficit for the third year in a row…………….but will they address their second largest expense – health insurance? They can cut millions while improving benefits at the same time but no one seems to have told them that…………………….Meanwhile a large municipality near Houston continues to sell city land to pay for health care for city employees…………..

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Underwriter Opines on Reference Based Pricing

Sunday, December 30th, 2018

By David Stanard   VP, Underwriting Manager at Excess Risk Reinsurance Posted on Linkedin

As an underwriter, I’m always surprised by the examples given when discussing RBP. They always seem to omit the fact that RBP has almost NO impact on an employers drug spend. In today’s market, that’s 30-40% of your cost.

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Reference-Based Pricing: a Welcome Disruption

Sunday, December 30th, 2018

Disruptors Change History in Boston – “Tea Anyone?”

These plans are a game-changer in our industry, and a much-needed disruption to the status quo……………

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