Trump has promised that “ (Rx) pricing for the American people will come way down.”
Trump has promised that “ (Rx) pricing for the American people will come way down.”
Learn how moving to self-insurance managed by a fully independent Third Party Administrator (TPA) linked to high value providers and services can reduce your total benefits spend by 20 to 40%.
Do insurance agents, brokers and consultants still receive undisclosed compensation from the vendors they recommend?
Like the old whore houses of the Wild West, patients at the Mayo Clinic may be directed to one of two waiting rooms. In the good ole days, upon entering the local cat house one was directed to one of two waiting rooms. The room on the left was for “second rate citizens” and the room to the right was saved for “1st class citizens” such as lawyers, doctors, and the wealthy.
If you are not getting 70-80% off billed charges you are getting screwed……………..This article proves the fallacy of hospital charge master rates which no one ever, ever pays……………
Under the leadership of the district’s risk manager, Mike De La Rosa, the Weslaco Independent School District has historically demonstrated an almost unequaled track record of “thinking outside the box” amongst Texas school districts.
Things are moving at light speed for TPAs, with new technology, approaches to disrupting traditional use of PPOs, carriers seeing TPAs as sources of business, increasing interest in participant engagement and widespread investor interest.
The game is over. Plan sponsors are becoming more educated. The secret ingredients of managed care contracts are now known to many. And they are mad as hell and not going to take it anymore.
Acquisitive insurance brokerage AssuredPartners Inc. is making a significant move into California with the purchase of Keenan & Associates in a deal that will push AssuredPartners’ annual revenue over $800 million.
With the acknowledgment that many benefits consultants drive decisions that are at odds with optimal health plan performance, benefits managers and brokers are increasingly advocating for consulting practice principles that align more directly with purchasers interests.
“No one is entitled to health insurance. No one is entitled to health care. And just as certainly no one is entitled to a $1 million bank account or one with unlimited funds. So where’s the beef?” – Molly Mulebriar
“This groundbreaking innovation in medical price transparency will further disrupt the insurance company dominated status quo and give patients increased leverage in obtaining the best value for their health care dollar,” says MediBid CEO Ralph Weber.
He founded the Wichita direct-care medical practice more than six years ago ……. He cited Allied National Inc. in Overland Park as an example of an insurance company whose profit margins have increased by incorporating the Atlas model………….
William Tecumseh Sherman, who laid waste to the South at the end of the Civil War, famously said, “War is Hell”. So, too, is health reform.
A recent request from one of our clients to their record keeper was simple; What have we been paying, on average, for certain procedures? The response/s in a string of emails lays out a simple request into one of enormous complexity, seasoned with a good dose of Bull S–T.
“It has been seven years since our first client exited the managed care world. Subsequently more clients have embarked on the same journey, most with equally good results. None have returned to the world of managed care” –
You may have asked yourself why health prices rise inexorably. Are escalator clauses, the automatic price increases common to many managed care contracts, the driving force behind trend factors?
Father of The Rope-A-Dope Method of Winning – Mohammed Ali
Attorney advises hospitals how to respond to Reference Based Pricing Plans…………..a revival of the Rope-A-Dope?
TRS-Care 1, 2 and 3 will go away………….There will be only one plan: a high deductible health care plan…….Premiums would be an estimated $430 per month, or $5,160 per year!…..The deductible of $4,000 would need to be met before plan coinsurance starts……There would be 80/20 coverage after meeting the $4,000 deductible…….The maximum annual out-of-pocket (MOOP) limit will be $7,150……There would be no prescription copays. All prescription coverage is part of deductible requirements……
Currently, many benefits consultants drive decisions that are at odds with optimal health plan performance. Organizational purchasers, benefits managers and brokers are increasingly advocating for consulting practice principles that align more directly with purchasers interests.
If passed, SB 789 would limit districts that may participate in TRS-ActiveCare to those with 1,000 or fewer employees. The bill would eliminate the traditional co-payment insurance plan option, leaving only one plan (high-deductible, no copays) Districts with fewer than 1,000 employees will be given a one-time opportunity to opt out of TRS-ActiveCare.
“The only difference between Republicans and Democrats is Republicans take a little longer to get there” – Molly Mulebriar
Insurance agents, sensing an opportunity of a lifetime, are lining up to feed on the TRS ActiveCare scraps.
The rising cost of employee healthcare has more small employer groups choosing level funding over their traditional fully-insured health plans. What are the advantages of this option for your small business?
Be prepared for double digit increases in all of your insurance rates – not just Property & Casualty
EthiCare performed a Medical Bill Review (“MBR”) Audit on the claim in question and uncovered $934,000 in billing and coding issues. It should be noted that EthiCare’s fee for performing the MBR Audit was only $5,000.
If a tech entrepreneur/CEO who isn’t a benefits professional (me) can readily find proven solutions that have been implemented in small/medium/large employers, school districts and municipalities, it points out that the biggest lie in healthcare is that it’s not possible to control healthcare costs.
This 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.
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.
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?
The 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.
Clueless 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.
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?…………………
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.
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.”
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.
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
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.
“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.”
Texas 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?”
“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. “
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 %*).
If 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.
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!”
“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.”
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
“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.”
Ask 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.
On January 23, 2017 Texas Finance Committee Chairwoman Jane Nelson created the health care cost work group…………………
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.
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.
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.
“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
Why advisers must move faster to untether commissions from group health rates
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.
If 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
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.
“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.
Price is To Damn High!
“All the current reform proposals are a delaying tactic to continue to protect healthcare providers from free market, legitimate pricing”.
Former Managed Care Intermediary
Legitimate prices mean networks would be obsolete………….
Government meted punishment against citizens may end. Individual freedoms may be restored………..
Samuel 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.
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.
The plan to sell (give) health insurance to undocumented immigrants is the first California casualty of the Trump presidency…………
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
“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.”
The following article was send to us from Brian Klepper, PhD, health care industry expert.