Archive for May, 2009

Texas Town Boasts Highest Health Care Costs in the Nation

Saturday, May 30th, 2009

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true

NCN

Saturday, May 30th, 2009

Good Afternoon,

below please find our new format for the monthly industry related articles I have been sharing with you.  Hopefully you are finding them informative, as well as useful.  If you missed any of the previous ones, you can print out a PDF copy below.

This month we are discussing “Fair and Reasonable Reimbursement”.  Would love to have any feedback you might have, as well as discuss how NCN could assist you.

Patti Brock-Chapman
Director of Business Development
NCN
222 West Las Colinas Blvd
Ste 1500, Urban Towers
Irving, TX 75039
972-373-2800, ext 114
pbrockchapman@ncnelink.com

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NCN Takes a Hard Look at Healthcare
The Fifth in a Twelve-Part Series
May 2009

Claim a Better Way

Now, for the first time in the industry, NCN powered by Data iSight can give payers, providers and patients access to the exact same information. This new, patent-pending reimbursement methodology ensures a variety of other benefits to all three parties as well:

Transparent Reporting to all parties facilitates open dialog and builds trust.
Defensible Methods are based on solid data to validate settlements and streamline the negotiation process,
Repeatable Results provide consistency over time and prove the superiority of the solution.
Lower Cost means increased savings for payers and patients on claims of any size.
Efficient Turnaround means providers aren’t kept waiting by the process.
Get Data iSight, the solution that benefits all parties with lower costs, greater savings and more peace of mind.

Questions or Comments

pbrockchapman@ncnelink.com<mailto:kbattaglia@ncnelink.com>

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What Constitutes a Fair and Reasonable Reimbursement?

[X]
Capturing savings in healthcare claims is important. Our rich media presentation, What Constitutes a Fair and Reasonable Reimbursement?<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5TY-cTR2bL_d8kiTd4PXm8MwaaGeEIyIh0C4VYCGG9s3MRsfT6AElN4Gq4bW9KfMytnQn1iNCM33G7RxNEvGQwAnI1R4vb87hHsQlu-I4fZYNey8XpmF7CDwMshLhoN-sA_5XYz_Rvz9Cw==>, explores:

*

All Over the Map – Healthcare suffers from erratic pricing methods.
*      An Unsustainable Model – Saturated healthcare markets can’t deliver promised savings.
*      An Unbiased Benchmark – Third-party data holds facilities accountable.
*      A Solution in True Cost – Cost-based methods change the trend of rising healthcare charges.

PDFs of Articles

Here are links to all the articles in our series, NCN Takes a Hard Look at Healthcare:

What Constitutes a Fair and Reasonable Reimbursement?<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5TYvAj6QR7jnPeEkdbJ-p6qA3eEpQgQhLMlomTAtN0LdiBBLFzQSeYX81n1LNr8uB-9eOWYTC_sX7xU89vGC7zWdInp4UpsjLoxzn4s4hu_5_IlNxjvPzufyuacQCwY_3AxScg4HBthjHQdRpKWErUXm_EPH5ccFx3crBhnZXCAX6LnoeSccuJGT>

Out-of-Network is a Good Place to Start When Trying New Technology in Healthcare<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5TYb6ZoL6K7wKEHs3DVwVBxR8i8dsMVJIGW4xtVdwgW_7nkBv4lw1vXTHwVrT35vxTgRgukuNx5GJMEGF13Itp3XzvBy1bu6KErCBMC6OqSx78bhGXdyCOZLpABk1k4mHFDArFO25C5moxYTVKHSsWEOUZABF3LCX4EKdFTdCgzVjY1RcmxxGLcZAbTswIYO3_4=>
<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5Tb-qDWoOV-RBANMx-Bn-uvYNYK6tCY-cGjp5ObLt075CcBRlLHFRVrTX1wjB49L17icp6CKpDl2DHnwA6hh2r3OWoOnQO9eNB5ouOZmAPNI6w==>

Are PPO Networks Relevant?<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5TaBBl8y2VpKY95fJnQKi1JtuukvOKDYqja3cTBnvbodi8VWZHZSkKaQA5d2gSWdipSParNCRsh43ZF1x0jPTvHY0AhWfebgzSUz3A7iqBV9vQQ9e7ls1DiQzhAwMu9bPMcgGd3v8zKETq6nT4FG7nhkBuYdnrapIPQ94j1VyMLfg_Sn5FMRyBoH> <http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5Tb-qDWoOV-RBANMx-Bn-uvYNYK6tCY-cGjp5ObLt075CcBRlLHFRVrTX1wjB49L17icp6CKpDl2DHnwA6hh2r3OWoOnQO9eNB5ouOZmAPNI6w==>

Costs vs. Billed Charges: What’s the Difference?<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5TaPG8hENCJCpHtOkTpLEqAkwtUvKKV2aSeDN7aiVBqKJN_b6qIgeyB-6gqKQp_mZ_l9Mzo3IoQ-kztMbprCny8NrD3iu6pPWVbPTYY4VmeAkLEnS7M0bsqYX9JxPC1Y2wcwn3ZLHJArVfuR5gVYdaI_8Wray-N4ocqbDmx4WGZkRRdgurz1Fc7BxOf7PLQiEmw=> <http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5Tb-qDWoOV-RBANMx-Bn-uvYNYK6tCY-cGjp5ObLt075CcBRlLHFRVrTX1wjB49L17icp6CKpDl2DHnwA6hh2r3OWoOnQO9eNB5ouOZmAPNI6w==>

Can Transparency Really Reform America’s Healthcare?<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5TYvBVyfi5cDFqjhtOvWz9okwkh_CPEqZz5MOZo-v3Qji3olkCV_bc2C9DFbqwUrfdp7NFQN4wPBCmlpfRgFVwovXSuaq-SzQPyCSrkiPBsOLqPytHhaDWWlF-cSk-a6wj2VUJmuFi-mW-IFKpokee3v6OEJBOxlRE5AU7CLhT76Pc4DhFFqDjo->

About NCN

NCN<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5Tb-qDWoOV-RBANMx-Bn-uvYNYK6tCY-cGjp5ObLt075CcBRlLHFRVrTX1wjB49L17icp6CKpDl2DHnwA6hh2r3OWoOnQO9eNB5ouOZmAPNI6w==>
[X]
is the national leader in cost management for out-of-network claims. We use cost-based data and transparent reporting to maximize savings on healthcare claims. At NCN, we claim a better way for payers, providers and patients. View a rich media presentation about NCN’s patent-pending cost-based methodology.<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5Ta9XgSHtshdIMCQLcjzihLKSVy6ZeZiwWr5CvrRC0wnN1nxuGNgC7eig4I4_P35XeLY8nRJ9q2aDIBVu1upnOCMRG9rS_oUeXNHLboVA4Zh5BsnHUYf7lC9GlIBno2JiPFKSEaX_P0U0Q==>

NCN at AHIP’s Institute 2009

If<http://rs6.net/tn.jsp?et=1102587100702&s=29&e=00172ABKRdj5Tb-qDWoOV-RBANMx-Bn-uvYNYK6tCY-cGjp5ObLt075CcBRlLHFRVrTX1wjB49L17icp6CKpDl2DHnwA6hh2r3OWoOnQO9eNB5ouOZmAPNI6w==> you’d like to meet with NCN reps at the Institute in San Diego, please contact Kelly Battaglia<mailto:kbattaglia@ncnelink.com>, Manager of Marketing Services.

Battle Over Future of Health Care Begins

Saturday, May 30th, 2009

Sent to you via Google Reader

The Health Care Battle Begins

Sen. Edward Kennedy (D-Mass.) has begun circulating drafts of his proposed health care reform legislation. Initial reports, including an op-ed in the Boston Globe by Kennedy himself, suggest that the bill will contain every one of the bad ideas that I outlined in my recent Policy Analysis on what to expect from Obamacare.

Among other things, the Kennedy bill will call for:

-An employer mandate;
=An individual mandate;
-A so-called “Public Option,” a Medicare-like plan that will compete with private insurance;
-The use of comparative-effectiveness/cost-effectiveness research to restrain costs;
-Subsidies for families earning as much as 500% of the poverty level ($110,250 for a family of four).
-Insurance regulation, including guaranteed issue and community rating. (He would also establish Massachusetts-style Connector); and Government-directed health IT.

There’s no indication yet of how much the plan would cost or how Sen. Kennedy plans to pay for it.

The bill will be formally presented to Senator Kennedy’s Committee on Health, Education, Labor & Pensions (HELP) sometime next week. Hearings could be held around June 10, and committee “mark up” could begin on June 17.

Senate Finance Committee chairman Max Baucus (D-Mont.) is expected to introduce his health care bill shortly before the Finance committee begins its scheduled mark up on June 10.

Meanwhile President Obama’s campaign apparatus is planning rallies and demonstrations around the country to build support for health care reform.

The battle over the future of health care in this country has begun.

Dental Plans – Direct Reimbursement Increases Employee Choices by 50%

Tuesday, May 26th, 2009

Dr. Pruitt, a Ft. Worth dentist, understands the problem with “dental insurance” and is not afraid to speak out.

http://healthcarefinancials.wordpress.com/2009/04/06/direct-reimbursement-dr-and-riskmanagersus/

Brownsville ISD Seeks Insurance Consultant – Again

Saturday, May 23rd, 2009

Brownsville Independent School District is seeking proposals for insurance consultant. This is the second time in the past two months that the BISD has sought proposals for insurance consultant. Apparently the Board of Trustees did not like the choices presented to them on the first go-around.

The administration’s recommendation was to re-hire the current consultant. One board member commented “why are we going to re-hire a consultant who last year recommended a change in PPO networks to save us money, when in fact we have not saved any money and are spending more?” A motion to approve died for lack of a second.

Proposal specifications will be released via the BISD website soon.

Editor’s Note: Can anyone verify that the current BISD PPO network has less provider discounts than the previous BISD PPO network of last year? Has anyone reviewed actual PPO provider agreements with the two Brownsville hospitals to compare? Has anyone reviewed each and every physician PPO agreement for all physicians in Brownsville and surrounding communities? Are all physician PPO contract the same, or do some physicians get paid more than others? Are 100% of the PPO “discounts” passed on to the consumer? Do PPO contracts contain excalater clauses that assure providers a “pay raise” every year? Do all PPO contracts with providers renew at the same time every year, or are the contracts renewed as the preceding contract term expires?  Has anyone asked the two Brownsville hospitals which PPO network would provide BISD with the lowest health care costs?

Senate Finance Committee Publishes Financial Options for National Health Care Plan

Tuesday, May 19th, 2009

Published today on the Senate Finance Committee website: http://finance.senate.gov/sitepages/leg/LEG%202009/051809%20Health%20Care%20Description%20of%20Policy%20Options.pdf

Switzerland May Restrict Broker Pay

Friday, May 15th, 2009

The government of Switzerland is considering changes to their Insurance Contract Act – a 100 year old Swiss law.  Among the proposed changes is one that says insurance brokers must be paid only by insurance buyers. If an insurer pays any sort of commission to the broker, the proposal says that the money  (commission) must be passed on to the policy holder.

Convicted Insurance Agent Remains Free

Friday, May 15th, 2009
Confessed felon, Arnulfo “Half Guilty” Olivarez’s sentencing has been postponed again. He was to have been sentenced this morning. Court records indicate a new co-counsel for the convicted insurance agent has appealed for more time to prepare for sentencing and is in the process of identifying witnesses to testify on behalf of his client.
 
New sentencing date is August 14. This is the fifth sentencing date set in this case.
 
Convicted felon and ex-insurance agent, Aaron Gonzalez, a business associate of “Half Guilty” Olivarez and former school board member of the Edcouch Elsa Independent School District has had his sentencing postponed eight times and is now scheduled for sentencing next month. Both plead guilty to bribery of public officials to gain lucrative insurance contracts at taxpayer expense.
 
Unfortunately we believe that public corruption is widespread in the Valley. Most are tight-lipped about it, and a nodd-wink mentality is the norm. But what we are amazed to see is that corrupt politicians and greedy insurance vendors are becoming increasingly careless in their quest for access to the public largesse. Could that be because there is little or no penalties if caught?
 
Corrupt insurance agents and politicians could not achieve their goals without the consent and active partipation of insurance companies participating in the scheme. Many commission driven company reps. with quotas will “look the other way”, knowing all too well the behind the scenes illegal activities employed to steer business the “right way.” We suspect that some even get kickbacks from the agents who end up getting the business. It seems to have come down to insurance agents “bidding” against each other for insurance contracts, i.e. the agent with the highest bid (bribe) gets the nod from key board members.
 
We hope that the upcoming sentencing of both admitted criminals include long prison terms as an example to others who are tempted to steal from the taxpayers.  And, we hope that the FBI has enough manpower to continue their work to uncover public corruption in the Valley.
http://www.themonitor.com/onset?id=2858&template=article.html

Dems Vow Passage of Health Bill By July

Wednesday, May 13th, 2009

Democrates have agreed to pass sweeping health care legislation by July 31yet they have no clue what they are going to pass. Like the stimulus bill, we suspect that 435 congressmen will be asked to pass the bill without reading it or debating it. 

http://www.foxnews.com/politics/2009/05/13/obama-announce-deal-health-care-reform/

San Antonio Employer Increases Health Plan Benefits and Lowers Costs

Tuesday, May 12th, 2009

http://www.reuters.com/article/pressRelease/idUS186154+11-May-2009+BW20090511

http://www.cnbc.com/id/30686579  

Admitted Insurance Felon to Be Sentenced

Monday, May 11th, 2009

Admitted insurance felon, “Half Guilty” Arnulfo C. Olivarez, is scheduled to be sentenced for his crimes in Federal Court, McAllen, Texas on Friday, May 15 at 9:00 am.  Bribery to obtain insurance contracts at the public’s expense is illegal. Unfortunately we believe that the practice is widespread and criminals experience a high success rate of not getting caught.  We hope that Judge Hinojosa hands down a long prison term as a warning to others who may tempted to extort monies from local taxpayers.

Despite his guilty plea last August, Mr. Olivarez is still a licensed insurance agent representing insurance companies such as Blue Cross & Blue Shield of Texas.

Former CEO Alleges Bid Rigging Conspiracy

Sunday, May 10th, 2009

Former CEO of the Brownsville Independent School District, Tony Juarez, filed a lawsuit against the district alleging bid rigging conspiracy regarding insurance bids received by the school district (See Jan. 17 article on this blog). As reported by the Brownsville Herald today, Joe Zayas, newly elected board member, told the superintendent in an executive session to “get rid of then Chief Financial Officer Tony Juaraz.”

“After a successful 14 year career in public school administration and finance, including eight years as deputy superintendent for finance and business operations of the San Antonio Independent School District, Juarez, 55, returned to his hometown of Brownsville to continue his career with BISD. He is a graduate of Brownsville Hich School who served in the US Army from 1972 to 1978 and graduated Cum Laude with an accounting degree in 1982 from Pan American University.”

But, ” a buzz saw met him in Brownsville” according to the lawsuit.

Apparently Juarez would not go along with a conspiracy to recommend the highest priced insurance bid during a bid process. Instead he insisted that the low bid be recommended.

BISD is currently out to bid again for their group health insurance program. Will the highest cost proposal be awarded. Is the “fix” in?  Many in the insurance industry have “Red Lined” the BISD due to past perceived shenanagans.

As the discovery process continues, the truth will emerge. Unless, of course, a settlement is made and the matter hushed up.

Agents Earn Top Pay with Voluntary Employee Insurance

Friday, May 8th, 2009
Example  

ABC Group has 250 employees and is interested in offering voluntary products and will grant you face-to-face access to each employee.  The decision has been made to offer three products – our universal life, short-term disability income, and group accident policies.
 
The following assumptions will be utilized –
 
a) The average age of an employee at ABC Company is 42.
b) The broker is on a contract that yielded first year commissions of 90%, DI of 55%, and Accident of 52.5%.
c) Participation for life insurance is 25%, DI Plus (16%), and Accident (15%).
d) The annualized premium for each product could be as follows – life insurance ($442), DI ($450), and Accident ($176).
 
Hitting each of the targeted assumptions could yield $52,978 in annualized first year premium.

 

 

 

 

 

The commission revenue generated could be $38,717. 
 
Put another way, the broker has provided a solution that pays him/her an additional $12.90 per employee per month.  That is across all 250 employees – even the people who did not participate in the voluntary offering!

 

 

 

 

 Worksite marketing can be financially rewarding for insurance agents.

Some  worksite marketing companies have so many marketing levels that we wonder  how there is any money left to pay claims. Somewhere on this blog we wrote about a 350 San Antonio employer group that does not know that they have 46 agents getting paid on their voluntary products (See – How Many Agents Do You Have Mr. Employer?).

The example on the left was part of an email blast to licensed agents in Texas, from a large nationally known insurance company.

With the uncertainty facing many group health benefits brokers, we expect many will concentrate on the voluntary benefits side of the business in the coming months. With numbers like the ones in the example, many will find a move to voluntary benefits just as rewarding as commissions earned selling group health insurance has been for the past 20 years.

Years ago we were asked to market voluntary employee benefits for a large national insurance company. We declined as “our plate was full”. The fellow who tried to recruit us is now earning over $1,000,000 per year on renewals alone, and has recently landed two large national accounts (Southwest Airlines and Pep Boys). We love success stories like this one.

Outsource HR for $2.50 PEPM

Friday, May 8th, 2009

www.patientcare4u.com  This may be ideal for those employers whose HR department is understaffed, or doesn’t exist at all. And, it saves employers claim dollars with premium savings.