Archive for the ‘Uncategorized’ Category

The Man With 11 Hips

Sunday, January 7th, 2018

Even with thirty years of experience as an actuary in the insurance industry, it took me a year to figure this out………

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To Win Accounts, Stop Competing

Sunday, January 7th, 2018

This is another great article from Griswold. Some say competing against the large brokerage houses like Gallaghers, Higginbotham, Willis and others is tough. It’s not………………………….

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Supply Chain Management Is Launching A Benefits Revolution

Sunday, January 7th, 2018

A few months before adviser Mick Rodgers of Boston’s Axial Benefits Group was named EBA’s 2017 Employee Benefit Adviser of the Year, he and 29 other forward-thinking benefits advisers from across the country signed their name to the “Declaration by NextGeneration Benefits Advisers that declares nothing less than a revolution in employee benefits.

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Buying Business

Saturday, January 6th, 2018

       “How Sweet It Is!

Agreement gave the Blue Cross the health plan business, including administrative services and possibly reinsurance coverage, for six years. In exchange, Blue Cross and Blue Shield gave the plan sponsor more than $20 million………

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Pharma, Under Attack For Drug Prices, Started An Industry War

Friday, January 5th, 2018

It’s not easy to get Americans mad at a behind-the-scenes industry they’ve barely even heard ofbut pharmaceutical companies have spent most of this year trying………………“Who decides what you pay for your medicines? Not who you might think,” a concerned woman’s voice says in a radio spot airing in the District last month. “More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”

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Eliminating The Middle Man

Friday, January 5th, 2018

 

 

Embodiment of Corruption: Your Health Insurance Network

Friday, January 5th, 2018

Secret network pricing helps render patients defenseless against price gouging. It’s as absurd as grocers being permitted to keep the price of milk secret……………..

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Congress Outlaws Health Insurance – Workers Rejoice Over New Found Wealth

Thursday, January 4th, 2018

If 17.5% of GDP could be transferred to workers tomorrow, and health insurance outlawed, you would see……………………

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Made in China: New and Potentially Lifesaving Drugs

Thursday, January 4th, 2018

One new drug promises to stop cancer from spreading to other organs. Another would treat blood cancer. A third would use the body’s immune system to kill tumors.

All three show encouraging results, and need just one more step to be approved for use in the United States. The drugs have something else in common: They were created in China.

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Pharma’s Utilizes Blame Game Strategies To Defend High Prices

Thursday, January 4th, 2018

Public anger over pharma price gouging is running high…………”More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”

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340(b) Hospitals Vow Fight Over Program Cuts

Thursday, January 4th, 2018

Hospital groups are vowing to push forward with a fight against the Trump administration over changes to a federal drug discount program following a setback last week…………….

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Caught

Thursday, January 4th, 2018

3 weeks ago the facility quoted us billed charges of over $13,000 per dose for the patient’s chemotherapy drugs. We know the Wholesale Aquisition Cost of those drugs is under $700 per dose. (Thank you micromedex!) .

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Patient Cures Own Cancer With Kitchen Spice

Wednesday, January 3rd, 2018

Woman, 67, who battled blood cancer for five years ‘recovers after treating it with TURMERIC’ in the first recorded case of its kind……………….Doctors say her case is the first recorded instance in which a patient has recovered by using the spice after stopping conventional medical treatments…………..

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Why the U.S. Spends So Much More Than Other Nations on Health Care

Wednesday, January 3rd, 2018
“Great read: Why the U.S. Spends So Much on Health Care. Studies point to a simple reason: the prices, not the amount of care. But lowering prices would upset a lot of people in the industry. Most of the explanation for American health spending growth — and why it has pulled away from health spending in other countries — is that more is done for patients during hospital stays and doctor visits, they’re charged more per service, or both.” – John Glascock, AMPS

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Do You Believe In Magic?

Tuesday, January 2nd, 2018
Health care costs have remained static for years. We have the evidence. But health insurance costs have increased year after year. We know why.

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Medicare To Adopt Reference Based Pricing?

Tuesday, January 2nd, 2018

“A proposal from the Hamilton Project would give the Centers for Medicare and Medicaid Services (CMS) more resources to scrutinize medical technologies and allow the agency to experiment with “reference pricing”.

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Why American Doctors Keep Doing Expensive Procedures That Don’t Work

Tuesday, January 2nd, 2018

American doctors routinely prescribe medical treatments that are not based on sound science………………

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Monday, January 1st, 2018

Join the Austin Chapter of the Free Market Medical Association for our September Meeting on Wednesday, Jan 10th at 11:30a-1:00p at Independent Bankers Assoc of Texas 1700 Rio Grande St, Third Floor Third Floor – Doyle Conference Room Austin 78701.

 

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Definition of Fully Insured Health Plan

Monday, January 1st, 2018

“A fully-insured health plan is a bundled approach of smoke and mirrors wherein the House sets the rules and always wins.”

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Are you a Thermostat or a Thermometer? 

Monday, January 1st, 2018
 
In 2018, be memorable………………………………………….

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RiskManagers HealthCare Purchasing Coalition 2018

Sunday, December 31st, 2017

RiskManagers HealthCare Purchasing Coalition ™ is a high performance health care Management Services Organization founded on a simple proposition: Health care cost can be reduced while maintaining or even improving benefits at the same time.

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A Carrier’s Economist’s Take On ObamaCare

Saturday, December 30th, 2017

Blue Cross economist Michael Bertaut recently tweeted a series of posts explaining what has gone off the rails, and why.

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Removing Waste, Gimmicks, Cost Shifting & Tricks From Healthcare

Friday, December 29th, 2017

By Jeff Bernhard, President of Continental Benefits

When I see the below chart, it reminds me how much Employers need real solutions to get the wasted spend out of the system. 

When I see the info in the chart on the right it reminds me of an Employer with an eroding margin.  It also reminds me of the union member that doesn’t get a pay increase because unpredictable healthcare costs have eaten up the budget. 

Lastly, it reminds me of the school that needs to lay off 100 teachers because of the wasted, unnecessary spend in the system. 

It has been this way for the past 20 years and has gotten worse each year. 

I am so glad to bring a real solution, with reputable partners (TBA), in 2018 to the self-funded Employer market that helps self-funded Plan Sponsors get rid of this waste with no gimmicks, cost shifting or tricks.  This solution will work on a “A” carrier PPO network. 

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Protection Money In Healthcare

Wednesday, December 27th, 2017

“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices. I am positive we will one day see plan participants sue their plan for breach of fiduciary duties. We are seeing this trend among retirement plans, health plans will be next” – Bill Rusteberg

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The Haff Brothers

Tuesday, December 26th, 2017

 

 

A parents worst nightmare………………

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 80+ Drugs to Be Dropped By Insurance in 2018

Friday, December 22nd, 2017

If you’ve got health insurance, now’s a good time to be paying attention. Each year, prescription coverage changes, and yours will likely be changing in 2018…………………..

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This old drug was free. Now it’s $109,500 a Year.

Friday, December 22nd, 2017

“As long as third party intermediaries continue to pay for these high cost drugs, the manufacturers will remain at the trough…………Many of our clients remove these drugs from their formularies” – Bill Rusteberg

 

 

It takes balls to say ENOUGH IS ENOUGH I’M NOT PAYING THIS ANYMORE!

 

 

 

Self-Funded Plan Sponsor Discovers He Has Balls……….

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School Board Members Rejoice: It’s Ok To Accept Bribes Between Friends

Wednesday, December 20th, 2017

A Texas jury has ruled it OK for school board members to accept bribes if the transaction is between friends. Therefore, bribes exchanged between enemies must be illegal…………………………..

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The “Secret” Driver of US Health Care Costs: Politicians Wanting to Get Reelected

Tuesday, December 19th, 2017

“If you told me six years ago that we’d be able to find that when a hospital had a payment increase, a member of Congress representing that hospital got a funding increase, I would have laughed you out of the room……………..”

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Challenging Oncology Therapies With Moonshot Price Tags

Tuesday, December 19th, 2017

SOURCE: Brian Klepper

New oncology therapies carry astronomical price tags—most people know this. Receiving far less attention is the question of actual therapeutic value……………..

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Wired For Sound – FBI Builds Insurance Corruption Case

Monday, December 18th, 2017

Humana representative Andrew Grove, whom prosecutors named as an unindicted co-conspirator, recorded a May 2013 conversation between himself, Mullen and Hernandez……………..After being confronted by the FBI, Haff agreed to cooperate and began secretly recording conversations ……………….Joshua Cerna was cooperating with the FBI by then, and in a recording of their conversation………………………..

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Feds Rest In Insurance Bribery Case – Are Bribes Gifts Between Friends?

Sunday, December 17th, 2017

“The Mullen Group had 20 accounts, but SAISD represented 80 percent of their commission revenue, so it was important to keep its relationship with Mrs. Hernandez,” Holmes testified…………….

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Trump Threatens Gravy Train – Insurers Pissed

Saturday, December 16th, 2017

 

 

Groups representing health insurers and consumers are urging state regulators to prevent the damage that could result from one of President Donald Trump’s executive orders……………..

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Universal Health Coin

Saturday, December 16th, 2017

The timing is right for the Universal Health Coin; it’s revolutionary, disruptive and anonymous utilizing blockchain for the future of healthcare……………………

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We Don’t Have To Buy Broccoli Any More?

Thursday, December 14th, 2017

 

Proposed tax bill, if passed, will eliminate the government’s broccoli mandate. Americans will no longer be forced to purchase broccoli. Currently, citizens who don’t buy broccoli are subject to a  broccoli tax as much as 2.5% of income.

A spokesman for the American Broccoli Association stated “Broccoli is a right, not a food. If broccoli consumption declines, we will see people die in the streets. We are gonna do everything we can to turn this around in 2018!

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If A 1.4 Million Life Case Can’t Solve Rx Costs, How Can You?

Thursday, December 14th, 2017

Rx costs are bankrupting health plans across the United States. Rx costs amount to 25-35% of total health care spend and rising. Many plan sponsors are besides themselves, failing to reign in costs. Instead, they suppress wages and hire less employees………………..

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FBI Informant Testifies – School District Insurance Contracts Attract Rogue Agents

Thursday, December 14th, 2017

Conspirators forged a conspiracy that lasted from 2007 through 2015, federal authorities contend.

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San Francisco Increases Health Care Contribution Requirement

Wednesday, December 13th, 2017

 

Ordinance requires employers with at least one employee who works within the city limits to either pay at least a specific amount per hour worked within the city and county limits (or for paid time off) towards the cost of health coverage for any such employee, or pay a surcharge over to the city…………

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The Texas Medical Board Substantially Revises Telemedicine Regulations

Wednesday, December 13th, 2017

The Texas Medical Board’s (the “Board”) adoption of new telehealth licensing regulations may finally put to bed long-running challenges to the state’s historically rigid position with respect to healthcare services delivered remotely via telemedicine…………..

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All Businesses Operate a Health Care Business Unit, and It’s Losing Money

Tuesday, December 12th, 2017

The status quo insurance broker focuses the renewal conversation around carriers, networks and plan design changes. Focusing on these areas and not the health-care supply chain does absolutely nothing to reduce true costs.

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Half Pregnant Tulip Lovers vs Cliff Dwellers

Tuesday, December 12th, 2017

 

 

 

The problem is there is no such thing as being half pregnant. A half pregnant approach only extends and aggravates any pain associated with change and simply takes longer than necessary to achieve the end goals  which are  lower costs, better benefits and higher wages.

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Healthcare Stole the American Dream – Here’s How We Take it Back

Saturday, December 9th, 2017

Dave Chase explains how healthcare has stolen the American Dream……………..

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The Mystery World Of PBM’s & The Black Box

Saturday, December 9th, 2017

The price you pay is all a black box………………………..

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The Decline of Employer-Sponsored Health Insurance

Saturday, December 9th, 2017

Working families across the country are spending more of their income on insurance that doesn’t protect them as much as it used to………………….

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Saturday, December 9th, 2017

“If one has a brain and a backbone, they can achieve amazing things in health benefits. “ – Dave Chase

Socialism Spawns Medical Flea Markets

Friday, December 8th, 2017

Peddlers offer everything from antibiotics to contraceptives laid out among the traditional fruits and vegetables…………

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Remember This?

Thursday, December 7th, 2017

Wednesday, December 6th, 2017

Flu Season To Be Historic?

Wednesday, December 6th, 2017

America is set to endure one of the most perilous flu seasons in years – with doctors warning it could be similar to the deadly 2014 outbreak. 

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DELUCA v. BLUE CROSS BLUE SHIELD OF MICH. – Plan Sponsors Beware!

Wednesday, December 6th, 2017

Plan sponsors and their administrators are increasingly at risk of legal exposure for breach of fiduciary duties. This lawsuit is an early example. Experts in our industry suggest more to come, rivaling the potential to earn more in legal fees that will make the famous Tobacco Settlement look like peanuts.

The weapon of choice of plaintiff’s attorneys is:

Section 502(a) (2) of ERISA authorizes a beneficiary to bring an action against a fiduciary who has violated Section 409. Massachusetts Mutual Life Ins. Co. v. Russell, 473 U.S. 134 , 140, 105 S.Ct. 3085, 3089, 87 L.Ed.2d 96 (1985). The Supreme Court explained in Russell that “[a] fair contextual reading of the statute makes it abundantly clear that its draftsmen were primarily concerned with the possible misuse of plan assets, and with remedies that would protect the entire plan, rather than with the rights of an individual beneficiary.”

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Just A Guess But…………………………..

Tuesday, December 5th, 2017

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Welfare Causes Workers To Work Less

Monday, December 4th, 2017

The tragic truth of where our country is heading can be found in the article that follows. A growing welfare state is effectively eroding the American work ethic. In this article, a working American earning a good income decided to work less in order to receive welfare funded health insurance……………

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Renting Medicare’s Provider Network

Sunday, December 3rd, 2017

 democratrepublican

An idea with bi-partisan support?

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Health Plan Industry’s Worst Nightmare: Employers Realizing They Are Actually The Insurance Company

Sunday, December 3rd, 2017

Dave Chase

Any company over 100 employees or so is an insurance company in all but name. The wise ones are already self-insured……

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Saturday, December 2nd, 2017

Established in 1959, this TPA is one of the largest, privately-held insurance services organizations in the country…..

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Ever Hear of a 51 Year Waiting Period For Medical Coverage?

Saturday, December 2nd, 2017

Ever hear of a longer waiting period than 90 days? Paying for coverage for 51 years before coverage took effect brings cause for reflection…………….

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PHI Data Breach Warrior in Hot Water – Big Government Over Reach?

Saturday, December 2nd, 2017

Justin Shafer & Family

“A friend of mine was released from unlawful confinement today. I’m a happy man” – Darrell Pruitt

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Ternian Develops PPO Network in Mexico

Tuesday, November 28th, 2017

Helping members in border states maximize their benefits: Ternian develops new PPO network of providers in Mexico
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Indians Are Restless – “We’re Not Paying This!”

Tuesday, November 28th, 2017

We’ve heard of shareholders’ lawsuits – it’s high time Plan members hold decision-making entities responsible through Plan member lawsuits……………….

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The Cost of Health Insurance Would Drop With This Legislation

Tuesday, November 28th, 2017

One reason health insurance companies are so strong and controlling is that they are exempt from antitrust regulations, allowing them to conspire on premium pricing…………………

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Insurica

Tuesday, November 28th, 2017

Placing nearly $1 billion in annual premiums for our clients, INSURICA is among the 50 largest insurance brokers in the United States and is currently the 27th largest privately-held independent agency in the country.

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Get It Done With A Freelancer Like RiskManagers.us

Tuesday, November 28th, 2017

Grow your business with the top freelancing website.

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ERISA Experts Provides Plan Sponsor Support

Tuesday, November 28th, 2017

The Employee Retirement Income Security Act (ERISA) of 1974 establishes minimum standards for retirement, health, and other welfare benefit plans, including life insurance, disability insurance, and apprenticeship plans.

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3000 Insurance Group Specializes In Association Sponsored Insurance Plans

Tuesday, November 28th, 2017

Oklahoma insurance agency specializes in association sponsored insurance programs since 1955………..

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As Health Care Changes, Insurers, Hospitals and Pharmacies Team UP

Monday, November 27th, 2017

Now that federal officials have quashed the mega-mergers proposed by the biggest insurers and blocked a deal between two large community pharmacy chains, established players in the health care industry are venturing beyond their traditional lines of business……………

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CEO: You Run a Health Care Business Whether You Like It or Not

Sunday, November 26th, 2017

WHO, ME?

Warren Buffett said it all: “GM is a health and benefits company with an auto company attached.” In fact, it spends more on health care than steel, just as Starbucks spends more on health care than coffee beans………….

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Destroying Evidence – A Time Tested Strategy

Sunday, November 26th, 2017

Sutter Health intentionally destroyed 192 boxes of documents that employers and labor unions were seeking in a lawsuit that accuses the giant Northern California health system of abusing its market power and charging inflated prices, according to a state judge……

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Rx Savings Solutions

Sunday, November 26th, 2017

For the more than 1 million members with access to the Rx Savings Solutions desktop and mobile app, saving money on a medication can sometimes require a new prescription from their prescriber. They can now request and initiate this switch in a matter of seconds…………………

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A Thanksgiving Message From Brian Klepper

Wednesday, November 22nd, 2017
Here’s wishing all my colleagues on this listserv a very happy Thanksgiving, with deep gratitude for your energetic and thoughtful participation in discussions about how to leverage high performance health care in ways that positively change our health system.
Kaiser Health News ran this lovely article about setting aside some time tomorrow to talk about everyone’s end-of-life wishes. I lost my precious wife Elaine 3 years ago today, but because we were fastidious about specifying how we wanted it to go, it was as smooth and satisfying an experience as possible. We never know what awaits us, and I can’t begin to express how important this is.
One more thing. In honor of Elaine’s memory, here’s a wonderfully sweet piece she wrote on end-of-life for TedMed.
Have a great weekend – Brian

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State Gifts Workers Who Have Sex – Xmas Every Day Makes For Happy Employees

Wednesday, November 22nd, 2017

Thanks To Santa having sex is less financially stressful now……….

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Does BCBS Manage Claims or Do They Just Pay Them?

Sunday, November 19th, 2017

One of my arguments about Blue Cross is that they do not manage claims, they just pay them…..

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PPO “Discounts” Off Billed Charges Mean Nothing

Sunday, November 19th, 2017

 

A fascinating study by Alan T. Sorensen in 2003 on PPO discount patterns is an instructive read. The State of Connecticut’s data of the state’s hospital industry provided Sorensen a rare opportunity to study payer-level differences in negotiated discounts for hospital services and gives the reader insight into certain myths the managed care industry (including carriers, TPAs, agents and brokers) have successfully foisted upon clueless consumers for the past 35 years.

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83% Of Business Leaders Think Their Insurance Agents Suck!

Sunday, November 19th, 2017

Benefits represent a company’s second largest expenditure, yet only 17 percent of business leaders think their programs are being managed effectively…………..

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How One Insurer Makes A Fortune By Reducing Healthcare Costs

Saturday, November 18th, 2017

“The best way to lower health care costs is to lower health care costs”……………”Healthcare costs are directly related to what we agree to pay for healthcare”…………………..”The secret to lowering health care costs is to find providers willing to take less and discarding providers who want more – it’s called Free Market”…………. “If you want to cut your health care costs by 50% and more, without sacrificing quality or level of benefits, you can…………………”

The following article proves all of the above:

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Request For Proposals – Non-Disclosure Statement

Friday, November 17th, 2017

By Bill Rusteberg

Acting as a fee based insurance consultant in managing a formal, public Request For Proposal process requires adherence to certain guidelines memorialized in statutes pertaining to political subdivisions.

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