Archive for the ‘Uncategorized’ Category

THE TRUTH (as we see it) About the Blues PPO Discounts

Saturday, February 25th, 2017

truthThis article is not being written because we won’t do business with the Blues or because we see them as the only carrier with faults. However, over the years we’ve gotten tired of hearing the misconceptions and deceptions about what is being offered and how and why they are able to make some of the offers that they do.

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Health Insurance Consultants Beware!

Friday, February 24th, 2017

witness

Insurance Consultant On Hot Seat

By Bill Rusteberg

Plan sponsors are taking their fiduciary responsibilities more seriously these days. Anxious attorneys have found a new and lucrative venue.

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This is Outrageous!

Thursday, February 23rd, 2017
mulebriarA few minutes ago I reviewed a 440 facility claim run on a school district. This information is not the type of information a plan sponsor will ever get from a BUCA. And, you will not find many TPA’s providing this information either.

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Spineless Republicans To Disregard Voters?

Thursday, February 23rd, 2017

spineless

First the republicans wanted the House to influence change. They got the House and did nothing. Then they wanted the Senate to influence change. They got the Senate and did nothing. Then they wanted the Presidency to influence change. They got that too and they continue to do nothing.

Do you trust Republican politicians any more? 

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Dark Horse Captures DART Account

Thursday, February 23rd, 2017

darkhorseThe Dallas Area Rapid Transit (DART) has spend the better part of a year or more evaluating their employee health & welfare plan. Health care costs have placed increasing budgetary pressure on DART’s operating expenses. Management knew something had to change to continue offering benefits. There had to be a better way to offer health care benefits and tame the health trend dragon.

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Has Texas Lost It’s Cajones?

Monday, February 20th, 2017

cojonassClueless politicians in Austin are in dire need of good advice from others than managed care providers, insurance carriers and medical caregivers who all have vested interests in continuing the status quo. Time is running out for common sense to have a place at the table this legislative session. 

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Super TPAs to the Rescue

Sunday, February 19th, 2017

 

 

He spent 20 years at Aetna, building and leading teams that sold health coverage to the largest employers in the U.S. Then transformation happened, and his heart led him to start a new type of TPA to do it better. Today – Jeff Bernhard, President of Super TPA Continental Benefits.

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A State-by-State Breakdown Of Hospital Adjusted Expenses Per Inpatient Day

Sunday, February 19th, 2017

childraisinghand

Would an old fashion indemnity plan work just as well as a convoluted PPO plan tied to egregious contracts of adhesion, i.e., managed care?…………………

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These 28 Hospitals Have The Worst Organ Transplant Outcomes

Sunday, February 19th, 2017

worstdoctor

Written by Heather Punke (Twitter | Google+)  | February 10, 2017

Whether or not a patient’s transplant is successful could boil down to hospital choice, as some hospitals have much worse outcomes than others, according to data from the Scientific Registry of Transplant Recipients.

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Texas School Trustee Arrested In Insurance Bribery, Kickback Scheme

Thursday, February 16th, 2017

saisd

Hernandez, 66, is accused of accepting cash, jewelry, and travel from people working for a school district insurance carrier and a paid independent insurance consultant for her influence on the district’s board of trustees and her vote on numerous insurance services contracts awarded to the companies with whom the co-conspirators had a financial interest.

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Paying Cash For Health Care

Thursday, February 16th, 2017

horsebuggy

As one observer put it, in describing our current claim process “a horse-and-buggy in a world contemplating driver-less cars, the healthcare industry’s consumer billing and payment system is an inefficient antique.”

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Edinburg ISD Seeks Insurance Consultant

Thursday, February 16th, 2017

Edinburg Independent School District, located in deep South Texas, is seeking a fee based insurance consultant to provide assessment, advice and guidance in the management of the district’s self-funded employee health & welfare program.

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Tuesday, February 14th, 2017

riskmanagers.logo

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

2014 RiskManagers.us All Rights Reserved

 

Employer Solves High Cost of Specialty Drugs

Tuesday, February 14th, 2017

potofgold

By Bill Rusteberg

A 400 employee life group in Texas, like many other employers across the United States, was experiencing high drug costs running into hundreds of thousands of dollars per year primarily due to specialty drugs. This self-funded plan had to do something to stop out of control prescription drug costs.

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Is Your Consultant/Broker Receiving Undisclosed Compensation?

Monday, February 13th, 2017

mulebriar

“In some cases, brokers can be paid undisclosed compensation, based on the size of their book of business with a carrier. ….. Many carriers also offer bonuses called “contingency” or “persistency” payments, where a broker is paid for keeping business in place, or providing “new placements.” According to an industry studies of benefits brokers, on average, 4-12% of a broker’s annual revenue  is derived from these undisclosed payments.”

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Will Texas Provide TRS ActiveCare Claim Experience Should Districts Be Forced Out?

Monday, February 13th, 2017

buzzardTexas school  districts of 1,000 employees and more may be forced out of TRS-ActiveCare and left to find their own alternative health care plans for employees. How are these districts going to find competitive bids without detailed claim experience? Will Aetna have market advantage? Will selected Aetna insurance agents/brokers have market advantage too? Will the state release claim information to each affected district?  Has marketing already begun, with agents circling the TRS ActiveCare carcass with the promise of “a safe harbor?” 

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Kidney Heists, Alligators & PPO Networks

Friday, February 10th, 2017

dendy

Mike Dendy

“The myth of PPO “discounts’ has been circulating for about 20 years now.  Blind belief in the myth costs employers and their employees millions of dollars on their health plans every year. “

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Sagebrush

Wednesday, February 8th, 2017

sage

ARE YOU LEAVING MONEY OUT THERE?

Recovering losses and preventing leakage in your claims-payments pipeline are your first steps to a better bottom line. Even responsible healthcare payers lose revenue due to overpayments (upwards of 7.0 %*).

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Hide and Go Seek

Wednesday, February 8th, 2017

hideseekIf your company was a self-funded customer of BCBSM at any time since 1994, it is very likely that you also have a hidden access fee claim……………Even small companies can have hidden fee claims worth hundreds of thousands of dollars.

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Cars, Hotel Rooms & PPO’s

Sunday, February 5th, 2017

hotelroom 

Room Cost Reduced 60%! Now Only $40,000

“If you think PPO programs save you money, rethink and ask yourself, compared to what? The average national PPO pays hospitals over 250% of Medicare. It will get worse next year and the year after when annual PPO-Hospital escalator clauses go into effect. PPO’s are a contract to overpay for healthcare services!”

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Undercover Work Exposes Bonus Arrangement For Insurance Consultants

Saturday, February 4th, 2017

mulebriar

“Yes, and it’s beautiful! The client does not have a clue about this. It will not show up on the 5500 Form either! It simply is not disclosed at all to the client.”

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RiskManagers.us Opens 4 New Offices

Thursday, February 2nd, 2017

This is the future office.

“Why would you invest in so much expensive real-estate for your employees? The Future office is already getting into the backyard of the new economy employees and companies. It is about results and not about presence and losing many many hours by traveling to your main office” – Unknown Author

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Why Healthcare Costs Are So High & Why Fixes Are So Difficult

Wednesday, February 1st, 2017

confused“One consultant relayed how he had reviewed claims data and found self-insured employers are paying up to 250 percent of what Medicare pays for the same service. By direct contracting he has helped his clients get rates of 150 percent of Medicare’s price.”

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Report Warns of Financial Catastrophe for State Health Plans

Tuesday, January 31st, 2017

coolaid

Without action, TRS-Care will eventually fail altogether……..Is Reference Based Pricing the Solution or will Texas continue to drink managed care cool aid?……………..or  follow Montana’s example? Montana Adopts Reference Based Pricing Strategies

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Shared Perceptions: Yellow Cab, Kodak, General Motors, Borders & U.S. Health Care

Tuesday, January 31st, 2017

yellowcabAsk most Americans about obtaining their health care outside of the United States, and they respond with disdain and negativity……. Of course, that’s exactly what Yellow Cab thought about Uber, Kodak thought about digital photography, General Motors thought about Toyota and Borders thought about Amazon. 

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Texas To Tackle Health Care Costs

Monday, January 30th, 2017

nelson Jane Nelson

On January 23, 2017 Texas Finance Committee Chairwoman Jane Nelson created the health care cost work group…………………

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Liability Needle For RBP Lawsuits

Sunday, January 29th, 2017

needle111

By Bill Rusteberg

Reference Based Pricing plans have been around for many years now. Fear of lawsuits by medical caregivers is a concern for middle and late adapters of the model, causing many to pay a premium for protection against them. And, the cost to do so can be significant. 

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Does Your Insurance Consultant Have Proper E&O Cover?

Saturday, January 28th, 2017

naked

Going Bare VS Looking For Cover

Does your insurance consultant have proper E&O cover? You may be surprised that is answer may be “no” in some cases. 

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There Is A Proper Way To Repeal Obamacare

Wednesday, January 25th, 2017

alanpreston Dr. Alan Preston

Revamped health savings accounts, portable employee plans would ease financial burden on consumers

By Alan Preston, For the Express-News January 21, 2017

One of the campaign promises of the Trump administration is to repeal and replace the Affordable Care Act, and Congress is working on precisely that. As with most legislation, the ACA has parts that are helpful and parts that are hurtful. Some of the good or bad of the law depends on whether or not you benefit from it.

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Killing Snakes

Wednesday, January 25th, 2017

snakes

“I come from an environment where if you see a snake, you kill it. At GM, if you see a snake, the first thing you do is hire a snake consultant. Then you get a committee on snakes and discuss it for a couple of years.” – Ross Perot

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Health Insurance Brokers Transition Into Survival Mode

Wednesday, January 25th, 2017

survivial 1

Why advisers must move faster to untether commissions from group health rates

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Mullen Sentencing Postponed To March 15

Tuesday, January 24th, 2017

mullen1

Sam Mullen has plead guilty to bribing an insurance consultant and faces up to 5 years in prison. Sentencing was set for Jan. 25, 2017 but now has been delayed until March 15.

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Broker Tip of The Day

Monday, January 23rd, 2017

tipofdayIf the ACA individual mandate goes away, the biggest loser for insurance brokers will be MEC plans while the biggest winner will be Short Term Medical plans. MEC plans offer limited coverage and often cost up to $100 per month while Short Term Medical plans offer comprehensive coverage at similar or lower costs. Smart brokers with MEC plans on the books should be prepared to adapt to what we believe will be a transformational market in 2017.

One broker is ready to accommodate the market – www.agilehealthinsurance.com

Monday, January 23rd, 2017

breakingnews

BREAKING: DOJ Wins Bid To Block $37B Aetna-Humana Merger

A District of Columbia federal judge on Monday sided with the U.S. Department of Justice in the government’s suit to block the proposed $37 billion merger between health insurance giants Aetna Inc. and Humana Inc.

Drug Company Raised Price of Life-Saving Drug 85,000%

Sunday, January 22nd, 2017

alcor“Questcor took advantage of its monopoly to repeatedly raise the price of Acthar, from $40 per vial in 2001 to more than $34,000 per vial today – an 85,000 percent increase,” said FTC Chairwoman Edith Ramirez.

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Survival Requires Killing Predatory Healthcare Pricing

Sunday, January 22nd, 2017

toodamnhighPrice is To Damn High!

“All the current reform proposals are a delaying tactic to continue to protect healthcare providers from free market, legitimate pricing”.

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The Coming Demise of PPO Networks

Sunday, January 22nd, 2017

beggar

Former Managed Care Intermediary

Legitimate prices mean networks would be obsolete………….

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Free At Last, Free At Last, God Almighty Free At Last!

Sunday, January 22nd, 2017

king

Government meted punishment against citizens may end. Individual freedoms may be restored………..

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Texas Insurance Agent To Be Sentenced Jan. 25? Paid Bribes To Consultant

Sunday, January 22nd, 2017

mullen1Samuel Mullen , who now lives in the Rio Grande Valley, appeared before U.S. Magistrate Judge John Primomo and pleaded guilty to conspiracy to commit honest services wire fraud. Sentencing was set for Jan. 25 before U.S. District Judge Xavier Rodriguez.

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Medicaid Changes Loom Large For Health Care Industry

Saturday, January 21st, 2017

medicaid11111

Medicaid is expected to remain a flashpoint as Democrat and Republican governors from around the country press the new Congress and President-elect Donald Trump to keep the ACA’s expansion in place.

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California Halts Health Insurance Plan For Illegal Immigrants

Saturday, January 21st, 2017

changemind

The plan to sell (give) health insurance to undocumented immigrants is the first California casualty of the Trump presidency…………

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Beginning of Repeal & Replace

Saturday, January 21st, 2017

freemarket111

ObamaCare is doomed. Everyone acknowledges that, including those who won’t admit it. But the mantra now is Replace. And the question is “With What!” The answer should a “Free Market”………………….It may just happen

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Doctors May Accept Low Fee From Medicare, But Not From All Patients

Thursday, January 19th, 2017

riplye

“I want to raise awareness of some specialists’ profit-driven behaviors,” said lead author Ge Bai, of the Johns Hopkins Carey Business School in Baltimore. “Then, we can look for solutions.”

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THE HEROISM OF INCREMENTAL CARE

Wednesday, January 18th, 2017

klepper

The following article was send to us from Brian Klepper, PhD, health care industry expert.

“We have a certain heroic expectation of how medicine works. Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors.”

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Cash Pay Health Plans – The Future of Health Care Financing

Sunday, January 15th, 2017

cashmedical“A provision of Obamacare requires health insurers to spend roughly 80 percent of premiums on medical costs. This was supposed to help control insurance costs.”

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Memo To Congress: Health Insurance is Not Health Care

Sunday, January 15th, 2017

mulebriar

“Everyone is talking about Congress repealing ObamaCare and replacing it with something else. How about replacing it with a free market?” – Molly Mulebriar

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UnitedHealth Group To Become Largest Operator Of Outpatient Surgery Centers

Saturday, January 14th, 2017

angryman“Screw You UHC!”

Hospital Administrator Reacts To News

A UnitedHealth Group division is poised to become one of the nation’s largest operators of outpatient surgery centers with a $2.3 billion acquisition announced Monday.

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Massachusetts Out-of-Network ED Physicians Charge 798% of Medicare Rates

Saturday, January 14th, 2017

outrageous12

Massachusetts out-of-network ED physicians charge 798% of Medicare rates

Written by Brooke Murphy | January 12, 2017

Here are six findings on healthcare cost trends in Massachusetts, according to the Health Policy Commission’s 2016 Cost Trends Report.

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How To Get A New Hip

Saturday, January 14th, 2017

'I guess I don't need to ask how your new hip is working out.'

www.ted.com/talks/allison_hunt_gets_a_new_hip#t-272889

What Is The Actual Cost Of An Employee’s Doctor Visit?

Friday, January 13th, 2017

cost1111There is a lot of discussion about the costs of healthcare, both for users and their employers if the employer is providing insurance.

Side Note: We have seen claim experience that document average cost of a doctor visit is $700. Yes, that’s correct, $700. This includes doctor charges, lab test, radiology, prescription drug/s. Consumers, shielded by low co-pays don’t see this, nor do they care. Four office visits in a year could eat up the premiums paid toward coverage. This is not insurance………….

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Thursday, January 12th, 2017

riskmanagers.logoRiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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Tenet To Sell Multiple Hospitals & Exit Health Plan Business

Wednesday, January 11th, 2017

tenet1Dallas-based Tenet Healthcare is seeking to further refine its hospital operations portfolio by selling hospitals in noncore markets………..Tenet expects to fully exit the health plan business this year.

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Are PPO Networks the Worst Negotiators in the World?

Wednesday, January 11th, 2017

unlockppo“An industry insider shared an example that I’ll anonymize. An analysis was done for a school district and one of the things looked at was where lab tests were done. This school district had nearly 1,500 metabolic profiles in the measurement period and paid well over $200,000 when they should have only paid under $10,000. Direct contracting/cash prices averaged 96% less in their market. That’s an average of $150 a test for what should be a $7 test.”

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Whole Foods Adopts Reference Based Pricing Model

Tuesday, January 10th, 2017

wholefoods Whole Foods has implemented Reference Based pricing strategies. AMPS ( advancedpricing.com) has acquired Whole Foods  as a client and is currently  managing a beta-test for them in Austin and in Los Angeles.

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Tucker Carlson Interviews Steven Weissman on Health Care Problems

Tuesday, January 10th, 2017

erick

Great Piece to Include on Your Blog. Tucker Carlson – Fmr Hospital Chief Steven Weissman on Health Care Problems  (4 minutes 27 seconds)

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Employers May Adopt ‘Narrow Networks’ of Health Care Providers

Tuesday, January 10th, 2017

confused“There are signs that employers’ interest in narrow networks may grow in the near future.”  But that is problematic. Why limit choice of providers when you can simply pay all providers the same? That solves access and financial issues for plan sponsors where the difference between profit and loss many times is tied to health care costs. Isn’t it about time consumers realize they are helping to drive costs up by accepting terms and conditions set by insurance companies and complicit plan sponsors too dumb to realize the implication of good intentions (providing employee health insurance) is having a reverse effect on their bottom line? – Signed: Ranting and Raving (Name held upon request).

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100 Year Old Doctor Still Working – Thinking About Going To Law School

Monday, January 9th, 2017

oldyoung

After decades of work at Massachusetts General Hospital in Boston, Dr. Walter Guralnick cut back. He’s now in the office just three days a week. It’s an achievement second only perhaps to his age. In November, he turned 100 years old.

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Britain’s Socialized Medicine In “Humanitarian Crisis”

Saturday, January 7th, 2017

good-news

“This is a national scandal,” Labour leader Jeremy Corbyn said in a statement.

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California Funds 1st Inmate Sex Reassignment

Friday, January 6th, 2017

gail

Hi, I’m Gail, Inmate # 206946

A 57-year-old convicted killer serving a life sentence in California became the first U.S. inmate to receive state-funded sex-reassignment surgery…………

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Will Potluck Dinners, Employee Terminations Attract More Paying Patients?

Thursday, January 5th, 2017

potluck1

Struggling to stem a red tide of falling income is tough when the core cause is not identified and addressed…………………..Could high prices be driving away customers?

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No Decision On Layoffs At MD Anderson

Thursday, January 5th, 2017

layoffHigher treatment costs left MD Anderson out of the Affordable Care Act marketplace…… the challenge for MD Anderson is funding a high level of research while facing a potential decrease in the number of patients receiving treatment……………………

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Oh Oh…………..Oh My God!

Thursday, January 5th, 2017

Man shouting, pulling hair

If GOP Doesn’t Replace Obamacare ‘Within Months,’ Insurance Companies Will Go Bankrupt

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This Is What Obamacare Repeal Will Do

Tuesday, January 3rd, 2017

dogchasingcare

I’m a former health insurance CEO and this is what Obamacare repeal will do…….

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Texas Opposes Sex Act

Monday, January 2nd, 2017

boobies

Washington bureaucrats  implemented a new rule in July that defined the term “sex” in the Affordable Care Act……………Texas says Sex is in the domain of state control, not federal oversight………

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Year End House Cleaning Discovery Finds Rare Antique Hospital Agreement

Saturday, December 31st, 2016

molly1Molly Mulebriar, margarita in hand and a bottle of scotch in the other, dropped by our office early this morning to begin New Year’s Celebration festivities. (She is the former Miss Texas 1984 Tequila Chugging Champion and to this day manages to maintain a competitive edge in adult beverage competitions).

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Hospital Contracts Made Simple – 120% Method

Saturday, December 31st, 2016

monkey Sam Crafting, M.D.

Sam Crafting 120 Hospital Contract For RiskManagers.us

Plan Sponsors, are you trying to direct contract with your local hospital? Dr. Crafting’s boiler plate Hospital Agreement may be just what you need….………..

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Classical Conditioning in Health Care Financing

Saturday, December 31st, 2016

pavlov Ivan Pavlov

By Molly Mulebriar

If hospital contracts include an annual escalator clause, whey then do these contracts need to be renegotiated every two or three years? An average escalator clause assures an annual increase in reimbursement from 4-6% or more. Isn’t that enough?

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BCBS To Lay Off 70% of IT Staff & Outsource to India

Friday, December 30th, 2016

boo11

Blue Cross & Blue Shield is planning to lay off 70 percent of its IT infrastructure staff and offshore the jobs to India…………

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BCBSTX Agrees To Pay Higher Health Care Costs? If So, Will BCBS Insureds Pay Higher Premiums?

Friday, December 30th, 2016

envelope And The Answer Is……..

Large hospital system had requested a 5 percent increase worth millions of dollars. Did BCBSTX agree to pay more on behalf of their insureds and will BCBSTX pass the cost increase on to consumers in the form of higher premiums? 

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Wanna Buy A Hospital? Feds Cut Funding For Financially Strapped Hospital

Friday, December 30th, 2016

bankruptcy

The penalty comes after news of a deal between Mission Regional and Doctor’s Hospital at Renaissance to save the financially-strapped Mission Regional, a non-profit, and help it expand as a short-term secondary health facility.

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Is Your PHI Safe in Government Hands?

Thursday, December 29th, 2016

secret1111

Nevada state government’s website was leaking thousands of social security numbers, and highly sensitive personal data. They said it was a hack. Spoiler alert: It wasn’t.”

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Klepper/Sutton Outline High-Performance Healthcare Solutions

Thursday, December 29th, 2016

box1111Thinking Outside The Box

“Healthcare has become defined by rampant excess, so effective benefit managers will, of necessity, seek unconventional solutions.”

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Cash Cows & Smoke Filled Rooms

Saturday, December 24th, 2016

smokefilledroom

“A national health care conspiracy between medical care givers and third party intermediaries has created a lucrative cash cow crafted through secretive collaborative contracts of adhesion in smoke filled rooms.” – Molly Mulebriar

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Friday, December 23rd, 2016

riskmanagers-logo

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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If You Could Go To The Doctor While At Work, Would You?

Friday, December 23rd, 2016

onsightcare

Employers are becoming more involved with the well-being of their employees—not just because it can reduce sick days but also because it can improve employee morale and help reduce medical spend.

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