Uncategorized – Page 4 – Risk Managers

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

In August of 2023, Advent Health fled a lawsuit alleging that MultiPlan’s business model of contracting with fellow payers and aggressively repricing out-of-network service payments is anticompetitive under Section 1 of the Sherman Act.

Will Government Grant Pardons To Death Row Inmates?

Government has been known to mandate certain life saving vaccines quickly, without years and years of clinical trials hobbled by a burdensome administrative state about as efficient as the U.S. postal service. Cancer patients dealt a death sentence wonder why a vaccine that’s been around for over a decade with a promising cure rate can’t be made widely available right now, before death do they part cancer’s death row.

Bernie Sanders Proposes Subpoenas of CEOs of J&J, Merck On Drug Prices

U.S. Sen. Bernie Sander stares to the front and leans into his microphone at a hearing — politics coverage from STAT

“Considering that drugs like Eliquis have net prices that are a fraction of the list prices – with so many of those rebates going to government programs – if the committee wants answers for why the prices are so high, maybe instead of pharma execs, they should subpoena a mirror” – Antonio Ciaccia

ValueHealth Benefit Administrators

Terri Raimondi – Senior Vice President, Business Development and Marketing

Benefit Administrators is progressive and committed—an authoritative Third Party Administrator known for flexible, innovative solutions and unparalleled customer service.

Lose Weight With GLP-1 Medication Prescribed Online & Delivered

Want one of those expensive employer paid weight loss drugs that’s bankrupting health plans without having to go through all the usual hassles of taking time off for work to see a doctor for a prescription? Now you can……………..

The Silent Epidemic Eating Away Americans’ Minds

By Marina Zhang

Billy was a bright 10-year-old boy with two Ivy-League-educated parents. He was book smart—got straight A’s in school—but lacked street smarts.

Insurance Coverage Makes Common Generic Drugs More Expensive

“Congress and state legislatures should consider allowing insurance plans not to cover common generic drugs. This move would fundamentally resolve the spread pricing problem created by pharmacy benefit managers, eliminate wasteful spending on these drugs and lower insurance premiums for all.”

The Baby Survived But the Mom Almost Had a Heart Attack When She Got the Hospital Bill

By Marshall Allen

‘That’s an incredible victory! But like many of these wins, it’s bittersweet, because it exposes an outrage. Neither the hospital nor the insurer had been complying with the Illinois law.”

US Drug Prices Are 8x the Cost in Peer Countries for Some Drugs

By Kelsey Waddill

For nine out of ten Medicare-negotiated drug prices, the US still faced higher costs than peer countries even with rebates.

Maintaining Access to Rural Healthcare Amid Closures

The cost of delivering quality care is higher than ever, while payers are looking to downsize reimbursement rates as much as possible.

The High Cost Of Weight-loss Drugs Is Threatening Coverage Altogether

By Lucy Peterson
January 16, 2024 at 08:45 AM

With the price of GLP-1s reaching well over $1000 a month, local officials are warning that rising costs threaten to quickly drain government spending accounts.

Assessing Early Experience With Arbitration Under The No Surprises Act

What is the No Surprises Act? “It’s a law that transfers balance billing liability from plan members to plan sponsors under certain circumstances gifting the balance biller a much better opportunity to recoup from a deep pocketed plan sponsor than from a Joe Sixpak.” Bill Rusteberg

Lloyds of London

By Paul Milller, London Market Insurance

In April, 1936, a piece of paper was passed around the Underwriting Room at Lloyd’s of London bearing at the top the notation “Queen Mary — £4,800,000”.

The Most Powerful Natural Pain Killer In The World?

You saw the media frenzy on Fox. – After 11 years of private testing, Conolidine “Nature’s Morphine” is now legal worldwide.

After a 100,000 person clinical analysis Conolidine is now certified as the most powerful natural pain reliever in the world…. Boasting pharmaceutical level relief with no negative effects.

Next Insurance

Unfair Business Tactics

By Bill Rusteberg

Health insurance brokerage is nasty business. It’s a replacement sale reliant upon destroying relationships. For some anything goes, colored under the heading “All Is Fair In War.” The good news is sometimes the good guys win. So how are they able to do that?

One Drug, Five Prices

Tom, Dick and Harry go to the same drug store to pick up the same drug, through the same PBM, on the same day. Each is asked to pick their price behind doors number 1, 2, 3, 4, or 5. Tom picks Door #1 much to the pharmacist’s displeasure. Dick picks Door #3 as the pharmacist nods approval. Harry picks Door #5 and the pharmacist belts out a joyful YES!

The Dark History Of A Pharmaceutical Company

Bayer is a German multinational pharmaceutical and biotechnology company and is one of the largest pharmaceutical companies and biomedical companies in the world.

Wholesale Generic Drug Pricing Will Amaze You & Piss Off Your PBM

ScriptCo is a membership-based pharmacy making prescription medications more affordable for everyone.

Smart Pharmacy Plan Bypasses Middle Men

SOURCE: Oniline Pharmacy – Employer Solutions | DiRx Health

“In bypassing multiple middlemen in the distribution chain, DiRx is streamlining the path between the manufacturer and the consumer…………………..”

Top Dog Or Underdog? Bargaining Power In Healthcare

By Ge Bai – Contributor|HEALTHCARE

In healthcare and elsewhere, the price of services and products is determined by the relative bargaining power between the buyer and the seller. A top dog can afford to walk away without entering the transaction, whereas an underdog cannot. Being the top dog or the underdog makes all the difference for prices in healthcare.

The Parable of The River

“One day, a group of villagers was working in the fields by a river. Suddenly someone noticed a baby floating down the river………….”

2024 RiskManagers.us Fee Schedule

“How Much Do You Charge?” is a question that invariably enters the conversation when meeting a prospective client for the first time. So in 2014 we published our fee schedule for all to see and marvel.

Marpai Hires The Best of The Best

Marpai Hires John Powers as President

MyHealthGuide Source: Marpai (Nasdaq: MRAI), 1/12/2024

NEW YORK — Marpai, Inc., an independent national Third-Party Administration company transforming the $22 billion TPA market supporting self-funded employer health plans, announced the appointment of John Powers as the Company’s President. Powers is an accomplished healthcare benefits executive with over 30 years’ experience. Powers was previously CEO of Homestead Smart Health Plans.

The Affordable Care Act Hasn’t Done Squat

Insurance protects one from loss. But how much of the loss is covered?

Helping People Feel (and look) Better In Deep South Texas

“The Lower Rio Grande Valley, like many other communities in the United States, is facing a diabetes epidemic. The growing health crisis of widespread diabetes threatens individuals, families, the health system, and the prosperity of the Rio Grande Valley community.” SOURCE: Preventing Diabetes in the Rio Grande Valley – FSG

Turtles, Birds And Rabbits

Will a full-body MRI scan help you or hurt you? A doctor gets his own scan and finds out…………….

Whiny College Professor Hates Aetna

A WHINY COLLEGE PROFESSOR POSTED THE FOLLOWING ON LINKEDIN:

“Stanford University moved its health insurance from California Blue Shield to Aetna. It is now January 9, and I have yet to receive a card showing my member number, which is the evidence of coverage virtually every pharmacy and medical provider demands in order to get service.”

Marpai Stock Tanks Despite New Management Team

9:30 CST 11 Jan 2024

By Bill Biloselhigh

The market could care less there’s new management in place at Marpai…….

American Health Care Has A Moral Problem

By Marshall Allen, Author – “Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win”

Early in my journalism career, I wrote about murder, drug deals and domestic violence. That’s wrongdoing our country rightly condemns.

Money Affects Behavior

Back in the day health insurance didn’t finance loan free loss, it reimbursed loss.

ICHRAs Designed to Minimize Offloading Bad Experience

By William G. (Bill) Stuart

Can companies shed bad claims risk by moving to an ICHRA to fund their employees’ medical coverage? Yes. But the law minimizes the opportunity.

Differences In The 30 Day Cost of Two Prescription Drugs

“As the call for clearer prescription drug pricing has grown, there could be significant shifts in the prescription drug landscape in the coming years … Concerns have arisen around manufacturers potentially raising costs for non-Medicare plans to recoup lost revenue from IRA price negotiations. … There are several situations that could result in increased or decreased costs for plan sponsors in addition to potential price shifting.”

Walgreens Settles “Falsely-Inflated” Drug Prices Lawsuit

Those of us in the health benefits field know Walgreens as one of the most expensive prescription drug retail outlets on the planet. Most of our clients have eliminated Walgreens from their network.

Fiduciary Liability Insurance

If your company offers health insurance benefits, then you most likely have a department of people that oversees the program. But did you know that if one of them makes a mistake your company could be held liable?

Conservative Momentum Builds to Lower Health Care Costs

The following content is sponsored by Conservatives for Lower Health Care Costs.

Recently, Big Pharma and Big Government have teamed up in a full-blown attack against free market solutions in the prescription drug market by focusing on Pharmacy Benefit Managers (PBMs) – which currently serve as the only real check on big pharmaceutical companies’ ability to set sky-high prices for prescription drugs.

This Reminds Me Of A West Texas School Superintendent

If you’ve learned a lot about leadership and making a movement, then let’s watch a movement happen, start to finish, in under 3 minutes, and dissect some lessons:

The KISS Method Of Selling

Skimming Money

PBM Representative Skims Off Drug Profits

Nearly half of every dollar spent by Medicare drug plans goes to private health insurers’ pharmacy benefit managers and wholesalers

By Wendell Potter

As members of Congress get back to business after the holidays, they seem to be poised to pass legislation that would address some of the abuses of pharmacy benefit managers (PBMs), the middlemen who extract so much money from the pharmaceutical supply chain.

The Ole PBM Switcheroo Strikes Again

CVS Caremark to kick AbbVie’s Humira off some formularies in favor of cheaper biosimilars

By Zoey Becker– This year, CVS Health plans to employ the classic “out with the old, in with the new” mantra when it comes to AbbVie’s Humira.

“CEO’s Waste A Shit Load Of Money On Health Care”

By Molly Gamble – There are many organizations in the United States that hold themselves out as advocacy organizations for better care for patients, but is that what they are really about?

Marpai Stock – 2023 “A Year To Forget”

With 2024 starting with new leadership, most notably with John Powers at the helm, hope springs eternal among patient investors.

The Best Salesman In New York

By night, Joe Ades dines with his fourth wife at exclusive restaurants, sips Veuve Clicquot at the Pierre, and goes home to a three-bedroom Park Avenue apartment. By day, he is something else altogether. At 72, the “peeler guy” in the Turnbull & Asser shirts is a New York legend.

Aldeen’s Sunday Morning Bathroom Read

A Weekly Read By Doug Aldeen

Activist New York Governor, Kathy Hochul, has vowed to protect New Yorkers from medical debt, limit hospitals’ ability to sue patients and expand financial assistance programs as part of her 2024 State of the State.

Snake Killing Consultants vs Animal Rights Consultants

“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

Mark Cuban Opines

Cold Calling

Peter Rosengard sells the world’s largest insurance policy on a cold call

Cold calling was scary as hell when I first started as a 22 year old selling cleaner, more efficient homes. After a day’s training, I was taken to a residential street in a nearby city and told “Ok Bill, get out and start knocking on doors.”

Federal Bureaucrats Allow Florida To Import Canadian Drugs In Bulk

FDA allows Florida to import prescription drugs in bulk from Canada.

By Berkeley Lovelace Jr.

The new policy will allow Florida to buy prescription drugs in bulk. The drugs will be made available through state-run programs such as Medicaid.

Our TPA For This Month Is……

HR. DEPARTMENT: Our TPA is Gilsbar……………… I, I, I mean HealthComp. Opps I meant to say Virgin Plus!………Forgive me, I think I’m losing my mind, I’m so confused!

CEO: But didn’t Hank Say……………………

Hospital Accused of Negligence

Family To Sue Over ‘Wrongful Death’ of Eddie Bernice Johnson

Late former Texas congresswoman Eddie Bernice Johnson’s family intends to sue Baylor Scott & White for alleged “medical negligence” that led to her death.

The Physical & Mental Effects of The Atrocity of War

Pharmacies across the country are dealing with a flood of requests for medical and alternative sleep medications…..In the last three months, close to a hundred thousand distress calls were registered about a feeling of loneliness, depression, anxiety, suicidal thoughts…………

Let’s Play Hospital Roulette!

“Our plan pays claims using Medicare as a benchmark plus a 50% bonus. In this instance that totals $1,350 for Joe Sixpak’s one hour emergency room visit” says the emaciated plan sponsor.

Yuzu Health – A Different Kind of TPA

Legacy TPA’s are slow to adapt to market changes and even slower investing in the latest technology whereas new, “upstart” TPA’s invest in the latest technology giving them a distinct advantage.

Mail Order Obesity Drugs

Eli Lilly launches website to get obesity drugs shipped directly to patients via telehealth

Attention Plan Sponsors! – Get Ready To Bend Over

Drugmakers to Hike Prices on 500 Drugs

Big pharma companies including Pfizer are planning to raise prices on more than 500 drugs this month, according to a recent Reuters report.

Group Captive Insurance

Group captive programs are a specialized form of health insurance that allows multiple employers to come together and collectively fund and manage their employee health benefits. It’s a win-win: companies gain more control over their health insurance costs and potentially save money by sharing the risks and rewards of their healthcare program.

Flight Insurance

Watch how Kingfisher, a sales representative for George Stevens Insurance Company, underwrites and sells a Flight Insurance policy in real time………….

Free Hospital Care In Rural Pecos County

Finding solutions to lower health care costs has never been easier for citizens of Pecos County, Texas. Most qualify for free hospital care provided by the only hospital in the county.

Aldeen’s Sunday Morning Bathroom Read

Sunday Morning Bathroom Read (1st Gag Clause Violation of 2024 Edition)

The Purple Cow PBM

For the Second Time, Capital Rx Makes the Inc. 5000, With Three-Year Revenue Growth of 903% Percent

Americore Health

“The company quietly loaned $600,000 to James on the condition that his political connections would bring the company funding from the Middle East.”

“Biden told me there’s not a single door in the country that we can’t open. So if I wanted to meet, you know, the head of Google, it’s a phone call” – Grant White, CEO

FDA Says Beware of Fake Ozempic

SOURCE: FDA warns consumers not to use counterfeit Ozempic (semaglutide) found in U.S. drug supply chain | FDA

[12/21/2023] FDA continues to investigate counterfeit Ozempic (semaglutide) injection 1 milligram (mg) in the legitimate U.S. drug supply chain and has seized thousands of units of the product.

Dr. Mandrake Kirby

Johnny talks about his visit to Dr. Kirby, an Eye, Ear, Wallet doctor……….

Law Firm Offers RBP Plans Competitive All Inclusive PEPM Fee

For less than $10 pepm (as low as $6) a national law firm offers Reference Based Pricing plans protection services against balance billing and full legal representation in case of a lawsuit.

Free Or Near Free Health Insurance Sets Sales Record

2024 Individual Health Insurance Enrollment Sets Record.

A record 19 million Americans are expected to purchase individual coverage with other people’s money for 2024 effective dates.

MILLENNIUM TRUST ACQUIRES MAESTRO HEALTH’S CONSUMER DIRECTED BENEFITS BUSINESS

The move demonstrates continued strategic growth and strengthens its position as a leading consolidator in the industry

Leaving Money On The Table While Facing 114% Loss Ratio?

These rates will save Killeen Independent School District $10,000,000 in 2024

“The proposed rates for Killeen ISD are higher than the region’s rates but are still going to save Killeen ISD about $10 million off of the projected spend if they had stayed with their current provider.“

Attachment Point Set At Expected Claims?

“Clear Point defies the constraints of the current market by offering an attachment point equal to the expected claim amount.”

Barakat Blamed For Saving Patient $1,000

“Now I have almost $2,500 more to go! I could have come closer to meeting my deductible, earning 100% coverage for the rest of the year, but NO, you had to introduce me to Chris Barakat!!” screamed the patient.

People in Costa Rica Live Longer Than We Do

By WILLIAM H BESTERMANN JR MD

Costa Rica is a country in Central America between Nicaragua and Panama. Central America is a harsh place, right? Refugees seeking asylum from Central America have created a border crisis in our own country with thousands fleeing horrible conditions and coming into the United States daily. Here is a shocking fact. Citizens of Costa Rica live longer than we do! Can that possibly be true?

Screw Health Insurance!

“Medical practice that rely to heavily on insurance based payments will at some point find themselves underwater.”

Santa’s Beard Insured By Lloyds of London

” Children can be a little rough so it gets tugged and pulled a lot, and then there is the soot and the danger of being singed when I head down the chimneys” – SANTA CLAUS

Unregulated Medical Sharing Program Assists Undocumented Alien In Need

Cancer stricken undocumented woman receives life saving medical care through an unregulated, no deductible, no network medical sharing program.

Harbor Health Provides Same Day Primary Care Access In Austin, Texas

Harbor Health expands to serve the entire Austin metro area. See us for primary and specialty care.

Hammer-Toe Doc Hammers Patient

“A podiatrist in New York City elected to use an assistant surgeon for a bunionectomy and two hammertoe procedures, both common surgeries. That assistant alone billed $169,410. Fair compensation as determined by our classification, edits, and review process was $632, or 0.37% of the assistant’s bill.”