Archive for August, 2009

Brownsville ISD – Does Consultant’s PPO Claim Analysis Belies Truth? Will BISD Save $5,000,000?

Monday, August 31st, 2009

Any devoted reader of this weblog will understand how we feel about Preferred Provider Organizations (PPO) and the value they bring to medical plan payers. All PPO’s, both rental networks and proprietary networks, will tell you that their discounts are the best. Yet none will show your their contracts with physicians and hospitals as they are “confidental and proprietary.” So, is there another way to prove that one network has deeper discounts than another?  Yes, say many insurance consultants, “let’s re-price a couple of claims through different PPO networks – we will certainly be able to distinguish the best discounts from the worst discounts.” This makes sense, or does it?

In prior postings we have attempted to show the reader that a claim re-pricing exercise is not an accurate method to determine a correlation between various networks. In fact, the process lends itself to fraud, whether intentional or not.

In the Brownsville Independent School District case, a large 7,500 employee South Texas employer, the PPO network discounts issue has been the driving factor in the district’s recent decision to change from the HealthSmart PPO network back to the Texas True Choice PPO network (effective October 1, 2009).  As a reminder to the reader, Texas True Choice was the district’s PPO provider prior to Healthsmart.

The district’s insurance consultant recently stated at a school board meeting that a change from HealthSmart to Texas True Choice, “assuming the same exact claims occur next year, will save the district anywhere from $4.5 million to $5 million next year.” That is a very bold statement indeed. Can the consultant back this up with solid evidence, or was a sample claim re-pricing method used to come up with this astounding figure.  Why would the local provider community willingly forgo $5 million in lost profits?

In February, 2007, at the time the Brownsville Independent School District was using the Texas True Choice PPO network, the district hired MedReview, LLC, a medical claim audit specialist firm with offices in Denver, Chicago, Philadelphia, Scottsdale, AZ and Thomasville, GA, to audit the district’s group medical claims.  (http://www.medreviewllc.com ) MedReview audited claims paid between October 1, 2004 and September 30, 2006, a period of time during which all claims were subject to the Texas True Choice PPO network discounts.

The objectives of the medical claims audit included, among five catagories, analyze “actual discounts produced by the provider network (Texas True Choice).” – Page 1 of the MedReview Report as submitted to the Board of Trustees.

“The audit covered all claims incurred during the period October 1, 2004 through September 30, 2006. For this period, Mutual of Omaha (acting at third party administrator of the plan – Texas True Choice was the PPO network) provided an electronic claims file which contained a total of 148,323 claims with total paid amounts of $54,579,542.” (page 4). ………….”A number of claims were identified that had been re-priced, or discounted, incorrectly by Mutual of Omaha which resulted in claim overpayments of $561,803.35.”

In addressing provider network discounts, MedReview wrote “During the audit period, the Texas True Choice network delivered an average discount of 34.2% on professional claims, 45.5% on facility claims, and 41.0% on all claims. Please note these calculations are based on all claims and all providers. It is not uncommon for provider networks to inflate their average discounts by excluding some types of providers that historically, give very small discounts, i.e, children’s hospitals.”

So, if MedReview’s analysis is correct, how do these “discounts” compare to HealthSmart’s discounts? Is there a $4.5-$5 million difference between the two?

Do the HealthSmart discounts for the twelve month period ending June 30, 2009 match or exceed the discounts achieved by Texas True Choice as reported by MedReview? Did 7 premature births skew the numbers? Was that taken into account by the consultant? Did the consultant re-price 100% of the claims as recommended by MedReview, or did the consultant re-price only a few selected claims?

In our opinion, after exhaustive analysis of various PPO networks over the past two years, as well as obtaining actual PPO contracts, both physician and hospital from various PPO networks, (we have a Blue Cross Hospital Contract, for example) it is our stand that PPO network discounts do not vary by much. With all hospitals joining almost all networks, there is little incentive to give one network a much better deal than another.  truth-about-ppo-discounts

The MedReview report is eye opening. It has good information which the Brownsville Independent School District would be wise to use in managing their health care costs. For example, the report shows that one physcian had 10,540 claims from BISD employees. The next highest physician regarding number of claims was 2,928. A review of physician #1’s claims as compared to his competitior’s charges would be most interesting to a bonafide risk manager. The most utilized hospital was Columbia Valley RMC. with a total of 2,625 claims as compared to Valley Baptist with 2,405 claims.

The Brownsville Independent School District should eliminate their participation in any PPO network and negotiate contracts direct with interested providers. Tyler Independent School District did just that four years ago and have cut their claim costs by 40-50% while maintaining superior benefits – much better benefits than those in place for employees of the Brownsville Independent School District. (www.gma-usa.com)

Most are not aware that physicians and hospitals will, and do, compete for business. Yet, we all still continue to rely on third parties to negotiate “discounts” on our behalf as third party beneficiaries of PPO contracts. Of course, we really dont know how good a job the PPO’s have done on our behalf in negotiating “good deals” for us. The “Trust Me” factor may be costing us money.  bill-miller-forbes

Editor’s Note: For a copy of the MedReview Audit Report, email RiskManager@sbcglobal.net.

The Lewin Group Analyzes Health Care Reform Bill

Saturday, August 29th, 2009

hr-3200-lewin_public_plan_national_all

Brownsville ISD Faces Critics – Insurance Decision Sparks Outrage

Friday, August 28th, 2009

“………………………..you cancel a healthcare contract with one of the largest health care group insurance providers and award it to an unknown company from Oklahoma, with few staff, only one nurse and no track record.”

A new website, www.carebrownsville.org calls for the ouster of four of the Brownsville Independent School District’s school board members. Concern is expressed on the district’s recent decision to change health insurance providers. How this plays out will be more than interesting.

A $40,000 funded compaign is rumored to be spent towards billboard advertising and television spots to be aired 200 times between today and Monday, just in time for next Tuesday’s scheduled school board meeting. (http://www.bisd.us/PDFs/Board_Agendas/09_10/Agenda%2009_01_09_Agenda.pdf) Who is behind this? Could it be Carlos Quintinilla of Accion America?  (http://www.accionamerica.com/ 

Carlos “The Bull Dog” Quintinilla

High Cost of Treating Pain

Thursday, August 27th, 2009

Pain management can be costly. Recently we had a client who was charged close to $1 million by a pain management clinic on a single employee who sought treatment at the clinic during a 12 month period. We intervened and questioned the costs of procedures. We received an analysis from another physician who reviewed the medical case notes, and found the treatment plan “irresponsible and unncecessary.”

Today, we were notified that the same pain management clinic is treating another client of ours, with ten office visits thus far costing the employer’s self-funded plan in excess of $13,000.

Of course, the patients have no clue as to the charges submitted by this physician.

http://portland.bizjournals.com/portland/stories/2004/11/22/focus1.html

Group Medical Malpractice Insurance

Wednesday, August 26th, 2009

Medical tourism is catching on fast with over 500,000 Americans seeking medical care abroad last year. Some self-funded employer groups are offering a voluntary medical tourism benefit as a method to achieve plan savings through use of accredited foreign hospitals. However, some are concerned about liability issues involved with foreign medical services. AOS, a Barbados based insurance company, has developed a product to address these concerns – http://www.aosassurance.bb/PublicHtml/malpractice_insurance.htm.

Of course, due dilligence is always paramount before placing cover.

China Moves to Cut Use of Executed Inmate’s Organs

Wednesday, August 26th, 2009

BEIJING – China has launched a national organ donation system to try to reduce its dependence on body parts harvested from executed prisoners, who make up the majority of donors, state media reported Wednesday. http://news.yahoo.com/s/ap/20090826/ap_on_re_as/as_china_organ_transplants

National Association of Purchasing Management – Sept. 23-25 South Padre Island

Wednesday, August 26th, 2009

The National Association of Purchasing Management, RGV Chapter, is having their annual conference on South Padre island next month. Purchasing managers from throughout the state attend this annual event. For more information go to www.napmrgv.org.

Illinois OK’s Contingent Commissions – National Implications

Tuesday, August 25th, 2009

Here we go………………..Illinois approves insurance contingent commissions. RIMS voices opposition – cites Conflict of Interests.

http://www.property-casualty.com/News/2009/7/Pages/RIMS-Fears-All-Brokers-Will-Get-Contingent-Fee-Okay.aspx

2009 Directory of Third Party Administrators Now Available

Tuesday, August 25th, 2009

http://www.tpadirectory.com/

Repealing ERISA?

Tuesday, August 25th, 2009

http://online.wsj.com/article/SB10001424052970203946904574298661486528186.html

UnitedHealthcare Announces New Plan for Asian-Americans (No, We Are Not Kidding)

Tuesday, August 25th, 2009


New Plan For Asian-American Market

With Asian-Americans being one of the fastest growing segments of the Texas labor force, we have created health plans and services specifically aligned to this emerging demographic. As of Aug. 25, 2009, you can begin offering the new UnitedHealthcare AsianTreasureSM Plan to groups with 2 to 99 eligible employees.

Plan Benefits and Services
Tailored to Asian Americans’ medical, linguistic and cultural needs, the plan includes:

  • 20 acupuncture visits per member per year with just an office visit copayment for
    selected plans.

  • Asian language broker service lines.

  • Network-based Asian physician and acupuncturist.

  • Health management and educational programs on Asian medical conditions.

  • Tools and services in Asian languages.

Plan Designs
Your clients can choose from over 33 different plan designs with competitive prices including:

  • Wide range of flat-dollar copayment choices for many common services

  • Primary physician office visits ($25 to $35)

  • Specialist office visits ($50 to $60)

  • Urgent care visits ($75 to $100)

  • Wide range of coinsurance choices

  • Network (70%-100%)

  • Non-network (60%-70%)

  • Calendar year and policy-year plans available

  • Deductible included in out-of-pocket maximum

Broker Toolkit Available
The AsianTreasure Broker Toolkit contains everything you need to make a successful presentation including: product grid, presentation deck, health tip sheet, sell sheet, product
Q & A and more.

For more information about the AsianTreasure plan or to obtain your broker toolkit, please contact your UnitedHealthcare representative.

© 2009 United HealthCare Services, Inc.

Employers Consider Domestic Medical Tourism

Monday, August 24th, 2009

Self funded employer groups are seeing savings as much as 75% by sending employees out-of-state for medical treatment – http://www.businessinsurance.com/article/20090823/ISSUE01/308239988. How about a heart bypass surgery for a global pricing of $10,000?

Marine Corps Veteran Speaks At Town Hall Meeting

Monday, August 24th, 2009

http://hotairpundit.blogspot.com/2009/08/marine-corp-veteran-at-town-hall.html

Confidential Insurable Life Insurance

Monday, August 24th, 2009

Need life insurance on an insurable interest (person) but dont want the insured to know the policy exists? A divorce in which the spouse pays alimony? – http://www.globalriskbroker.com/Life%20Insurance/Confidential%20Insurable%20Interest%20Life%20Insurance.htm

Insurance Bid Rigging Settlement Announced

Monday, August 24th, 2009

 

http://www.insurancejournal.com/news/national/2009/01/06/96760.htm

Undisclosed Broker Fees Driving Up Your Costs?

Monday, August 24th, 2009

http://www.riskvue.com/articles/fs/fs0412.htm

Why PPO Litigation is Increasing

Monday, August 24th, 2009

This article was written by Joe Paduda (www.joepaduda.com)

PPOs, or Preferred Provider Organizations, have been around for a couple dozen years. They are networks of credentialed (with varying degrees of rigor) doctors, hospitals, and ancillary providers that have agreed to provide lower rates for ‘members’ in return for some measure of exclusivity/promise that patients will be directed to use them. I’d note that this ‘promise’ is often not fulfilled, at least in the eye of the provider. That’s a whole separate issue, one we will likely get to in a future post.

As one good friend puts it, ‘PPOs are a box of contracts’, and not many PPO firms do much more than recruit, credential, negotiate, and contract.

Their popularity waxes and wanes, roughly in line with the underwriting cycle (as cost trends decrease, PPOs tend to grow, as cost trends increase, buyers seek more controlled networks and medical management systems).

Typically PPOs are owned by a large group health plan or specialty company such as a workers comp managed care firm. Many PPOs were built to market/sell to health plans and workers comp payers – Rockport, Coventry, and Interplan are examples of ‘vended PPOs’, as opposed to those built for the exclusive use of a healthplan.

The problem

There can be several issues with PPOs; lack of direction by the payer, inaccurate data, failure to maintain credentialing standards and ‘stacking’ are some of the more prevalent.

But of late another issue has been appearing more and more frequently – providers claiming they are not subject to a PPO contract and therefore should be reimbursed at U&C, or in the case of workers comp in many states, the state fee schedule.

Digging into the disagreements that arise when payers assert the providers are subject to a contracted discount, it looks like there are a few contributing factors.

First, some providers have contracts with many health plans and networks, and it canbe tough to keep them all straight. And, the PPO may have changed its name, merged with another firm, or been acquired since the original PPO contract was signed.

Those are the easy ones.

A knottier issue is caused by the mechanism of ‘provider selection’. When the provider’s bill comes into the healthplan/bill repricer, it is ‘checked’ against a database to determine if it is from a contracted, or participating, provider (known as a ‘par’ provider). This checking could occur either at the health plan/repricer, or the bills could be electronically sent to the PPO for the PPO to check par status and apply the discount.

What determines ‘par’ status is often the source of the problem. For example, PPOs want as many ‘hits’ as possible, so they err on the side of counting a provider as par if at all possible. The more hits, the more money they make (often), and the better they look to the payer. Payers like more hits because then the managed care folks can show the savings they deliver due to the discounts. So the payer side of the equation is motivated to use logic that assigns as many bills as possible to the par bucket.

To do that, payers often use a provider TIN (tax identification number) as the only criterion to determine par status. If a bill is from a provider with a TIN that matches some contract somewhere in the PPO company’s database, than the discount is taken. Payers may also use address, provider first name last name, and/or phone, but most try to use as few criteria as possible.

But large provider groups and hospitals and health systems often use the same TIN for many different service areas – outpatient surgery, inpatient, rehab, pharmacy, hospitalists, occupational medicine. And they rarely offer the same discount deal across all service types and locations. Some service types may not even participate due to the internal structure and demands of the health system.

Here’s real world example, provided by a consulting client. A bill from an occ med clinic hits a payer, who determines it is a par provider due solely to the TIN match. A 30% discount is taken, and the check cut. But the occ med clinic is not part of the original contract, which specifically states that discount is for inpatient medical services only.

The provider complains to the payer, who contacts the PPO, who eventually pulls the contract, says ‘oh, yeah, here’s the problem’, asks the occ med clinic to resubmit the bill, after which the bill may – or may not – be paid correctly.

Now multiply this by the hundreds, and it is easy to understand why some providers, fed up by the paperchase, are getting downright litigious. This leads to providers suing payers over a few dollars on an office visit – not to get those few dollars, but to force the payer to apply the correct repricing methodology.

If the PPO is the one doing the repricing (as is often the case), there is considerably less incentive to fix the problem. The PPO doesn’t have to handle all the calls (although in many cases they are involved at some level), figures many providers will not fight it as it isn’t worth it, and even if they do that’s a small price to pay for all those fees.

And that’s one major reason there’s so much litigation in the PPO world these days.

Congressman Mike Rogers Statement on Health Care Reform

Monday, August 24th, 2009

http://www.youtube.com/watch?v=G44NCvNDLfc&eurl=http%3A%2F%2Fwww%2Emikerogers%2Ehouse%2Egov%2F&feature=player_embedded

PPO Merger Announced

Monday, August 24th, 2009

“Large, broad-based, national PPOs have been faltering of late, as their ability to extract discounts from providers, especially hospitals, has diminished. Over the last few years we’ve seen the PPO market consolidate, with Beech bought by Concentra, First Health take over CCN, Coventry acquiring Concentra and First Health, and Aetna’s purchase of PPOM. ”

“Expect this to continue, but it’s a losing game. PPOs are a cost containment solution that has fallen out of favor. While there will always be a place for them (think out of area coverage, work comp, companies with widely spread workers) they will continue to lose share to more tightly managed networks, vertically integrated systems, and Blues plans. “

 http://www.joepaduda.com/archives/001600.html

Why Insurance Agents Fear Insurance Companies

Sunday, August 23rd, 2009

Brokers are beholden to the insurance companies they represent and know that moving business from them can bring them severe economic disaster. Every agent contract we have reviewed allow the carrier to terminate the agent/broker appointment at any time without cause. Overrides and bonuses (often not disclosed to the customer) based on production have the intended effect of “capturing” the agents self-interests controlled by the insurance company he represents. The broker/agent is thus held hostage by the insurance company at the expense of the interests of his client. This conflict of interest is not clearly understood by most employers who purchase insurance through independent brokers.

Thus insurance brokers fear insurance companies because they know the carriers  can, and have, terminated agent contracts at will.

Employers should demand full disclosure of all compensation earned by their agent/broker. This should include bonuses, overrides, servicing fees, commissions, vacations, vouchers and anything else of value. And, it should be contained within a  written contract between the employer and the agent/broker.

What Do All These Logos Have In Common?

Sunday, August 23rd, 2009

 

Some Things Are Fairly Easy to Predict

Saturday, August 22nd, 2009

Some policitical subdivisions are afflicted with a continuous  and consistant history of political business decisions rather than business, business decisions.  An astute and seasoned insurance broker does his homework first, prior to spending time and money chasing sales through a public bid process.

Some of the questions an insurance vendor would be wise to find answers, to evaluate his/her chances of success include: Does the political subdivision have a history of making political business decisions, or do they have a history of making prudent business decisions? Do they change insurance carriers and agents everytime a new Board of Trustees is elected? Who did they hire to act as their independent fee based insurance consultant? What is the track record of the consultant? Based on historical performance who does he seem to favor most often?  Do the carriers who have historically been awarded the business pay undisclosed fees and commissions? And which carriers do not as a matter of business practice?  Have past bid packages included complete and documented claim data, or has past bid packages provided sketchy and incomplete claim data? And, finally, an understanding of local politics is important in the insurance agent’s evaluation of his chances.

The “Art of War” should be required reading of those in the insurance industry specializing in political subdivisions. A battle to win can be fought within the enemy ranks without bloodshed – spys win wars, not battle ready soldiers.

Molly Mulebriar, a direct descendent of Nostradamus, offered her predictions on the Brownsville Independent School District’s move to change health insurance companies, agents and consultant/s back on April 27, 2009 on this weblog. To view her predictions, go to the April archives and find the posting dated 27 April. The password is “bidrigging”.

How American Health Care Killed My Father

Friday, August 21st, 2009

This is long, but well worth the read.  It summarizes one of the “root” causes of the health care mess we’re in.  Just follow the $…

the-atlantic-online-_-septe

Editor’s Note: This was sent to me by a medical doctor friend of mine in West Texas. I forwarded this to many of my insurance contacts within the industry – Many have written back stating that this is the best article on our health care system they have ever read. It is a long read, buy extremely interesting and informative.

Harlingen ISD Rejects Best & Lowest Bid

Thursday, August 20th, 2009

Harlingen Independent School District last week rejected what was purported to be the best and lowest health insurance proposal from Blue Cross & Blue Shield of Texas. Despite the recommendation of the district’s insurance consultant (as reported by the Valley Morning Star) to award Blue Cross the contract, the district awarded the group health insurance contract instead to Valley Baptist Health Plans. The Board of Trustees voted to retain Valley Baptist on a split vote.

A week earlier, the same insurance consultant recommended the Blue Cross Blue Shield proposal be awarded as the City of Harlingen’s health plan, but that too was rejected by the City Council on a split vote basis.

Rumors abound that the consultant for both entities may be on a suicide watch.

It has been a bad two weeks for eager Blue Cross sales representatives it seems. Touting superior PPO discounts and low rates, Blue Cross sales representatives have become enthusiastic order takes of late.  With strong financial reserves, a systematic draw-down of reserves through below market rates is current strategy it appears. 

The insurance community is small and will take note of these developments. Future RFP’s by either entitiy may be problematic for some potential vendors. Such are the pitfalls of bidding on political subdivisions.

Editor’s Note: See Jan. 4, 2009 post “Political Subdivisions Sometimes (Or All The Time) Make Political Business Decisions”  

 

David (Robert “Take No Prisoners” Rodriguez) Slays Goliath (Jeff “Im Clueless” Jacobi) In Harlingen

 

 Blue Cross agent from Harlingen

Potential Lawsuit in the Making?

Wednesday, August 19th, 2009

The Brownsville Independent School District insurance story will not go away anytime soon it seems. This front page leading story in today’s Brownsville Herald may portend of legal proceedings to come.

One good thing about a lawsuit is that the facts are exposed for what they are and become public record.

.brownsvilleherald.com/news/lost-101281-district-administer.html

Truth or Consequences – Old TV Show Revived Locally

Wednesday, August 19th, 2009

Our in-house forensic experts have successfully un-redacted the partially redacted tape (see previous posting; Consultant Touts Credentials). Below is the complete un-redacted transcript:

‘Just as background, just so’s you’ll know, about ah oh early mid 90’s there was a great deal of concern in the insurance industry about whether or not an individual’s licensed as an agent or licensed as a consultant. So working with the State Insurance Board, we came up with license a requirement for health insurance counselor specifically (to health the insurance industry)  I worked with the State Board of Insurance in developing that program and questions and also approached them also with the requirements of that process because we were having a great deal of trouble with consultants that were getting cases at a very low rate and them taking commissions on the back side.  I work very closely with the Department of Insurance with one of their divisions in the fraud area to help resolve those things that occurred throughout the state with other agents involved.  That can be confirmed very easily if you wanna call Mr. Mike Gieslen with the department of insurance.”

Facts:

1. The Texas Department of Insurance issued Life & Health Counselor licenses as far back as the 1980’s.

2. The Brownsville Independent School District fee-based insurance consultant did not obtain his Life & Health Insurance Counselor license until 2002.

3. Mike Geislin, Texas Department of Insurance Commissioner was not employed by the TDI in the early to mid 1990’s and was not appointed as Commissioner until 2005.

We report, you decide.

Summary of National Health Care Plan

Saturday, August 15th, 2009

http://www.taxfoundation.org/publications/show/24997.html

Molly Mulebrier Returns From Secret Assignment

Friday, August 14th, 2009

Molly Mulebrier returned today from a secret undercover assignment and is being debriefed by our staff. Contrary to published reports, Ms. Mulbrier was not on assignment to the Congo and was not banished from this blog – that was a brilliant ruse initiated by the editorial staff here to throw off private investigators and insurance brokers seeking the Brownsville Independent School health insurance contract.

Although our debriefing is not complete at this time, we are encouraged at the amount of factual information our investigative reporter has obtained. Actuarial data dating back to 1999 has surfaced, for the first time. This is a significant discovery with tremendous implications to the integrety of the request for proposal process.

As location, location, location applies to real estate, data, data, data applies to underwriting a competitive group health insurance program. He who has data wins, he who has good data wins a lot, and he who has real time data wins all the time.

We expect Mulebrier’s debriefing to continue over the weekend. Our team of private investigators have sworn an oath of secrecy until all information can be confirmed by Don Pedro and his editorial staff.

Insurance Consultant Touts Credentials

Thursday, August 13th, 2009

Recently, at a Special Called School Board Meeting, a member of the school board asked their insurance consultant if he was to receive any fees whatsoever from any source other than the fee paid to him by the district. His response was:

“Just as background, just so’s you’ll know, about ah oh early mid 90’s there was a great deal of concern in the insurance industry about whether or not an individual’s licensed as an agent or licensed as a consultant. So working with the State Insurance Board, we came up with license a requirement for health insurance counselor specifically (to health insurance)   I worked with the State Board of Insurance in developing that program and approached them also with the requirements of that process because we were having a great deal of trouble with consultants that were getting paid *********.   I work very closely with the Department of Insurance ******* fraud to help resolve those things that occurred throughout the state *******   That can be confirmed very easily.   *******”

So, we tried to confirm this.

Here are the Facts:

Texas Department of Insurance has been issuing Life & Health Couselor License since the 1980’s. The consultant stated that he worked with TDI in the 1990’s to develop the license. He was granted a Life & Health Counselor license on 8-21-2002.

We report, you decide.

Editor’s Note: The transcript above was from a tape of the meeting obtained by our staff this morning. The redacted parts of the transcript were parts of the tape that were overridden by exclamations of disbelief of the person taping the meeting. Excerpts of the redacted parts went something like this: Damn, I cant believe he said that!

A careful review of the entire tape reveals disturbing contridictions which we will not get into here. We believe a more formal setting for review and discussion is appropriate.

 

 

Amazing Insurance Presentation

Wednesday, August 12th, 2009

Today I witnessed an extraordinary meeting wherein a deep South Texas public school district, employing over 7,000 teachers and support staff, awarded a $38,000,000+ group health insurance contract to a new vendor recommended by a paid insurance consultant.

Being in the insurance industry for almost 40 years, I had a distinct advantage over most of the spectators who attended since I know the business and understand the semantics. What I heard at the meeting concerns me deeply, especially as a taxpayer of the Brownsville Independent School District.

The BISD fired the current claim administrator to “save money.” That is nonsense. A claim administrator does not save money for a client, they simply process claims.

If, as explained, the BISD claims went up last year, was it determined why? Not from what I heard listening to the paid insurance “expert.” All I heard was that a “claim re-pricing” exercise was employed.  A claim re-pricing exercise does not work, and I can prove it.

None of what I heard at this meeting adds up. I have a lot of unaswered questions. There must be more to this mystery.

Molly Mulebrier Spotted in Cuero

Tuesday, August 11th, 2009

Admitted Felon’s Sentencing Postponed………. Again

Tuesday, August 11th, 2009

Arnulfo “Half Pregnant, Half Guilty” Olivarez, whose sentencing was set for this coming Friday, will now have his day in court in time for the Thanksgiving holidays. The sentencing is set for 9:30 am on November 24.

This is at least the fifth time Half Guilty, Half Pregnant Olivarez has had his sentencing delayed. Could it be that the Feds want to keep him “on ice” for possible future indictments of fellow consipirators and then a plea deal in return for cooperation brokered with the Judge?

Brownsville Independent School District Shoots Messenger

Tuesday, August 11th, 2009

The Brownsville Independent School District will be meeting tomorrow to award third party administration services for their self-funded health insurance plan. The current TPA is HealthSmart which has everything to lose and nothing to gain from the BISD request for proposal process.

Rising medical costs to the school district is the driving factor to change TPA’s it seems. But that makes no sense at all since a TPA simply administers claims and have nothing at all to do with setting medical provider reimbursements. Could the proposed change have anything to do with a new Board of Trustees elected last fall?

If the BISD is concerned about rising medical cost, they should directly negotiate with area hospitals and doctors as did the Tyler Independent School District four years ago. Their costs dropped over 40% the first year, and Tyler has not had to reduce benefits or increase plan funding since.

http://m.brownsvilleherald.com/brownsville/db_15631/contentdetail.htm?contentguid=cFLcNwSU&src=cat

Truth Detector – Expose Your Consultant’s True Motives

Saturday, August 8th, 2009

Ever wonder what motivates your insurance consultant? Is he or she really looking out for your best interests or are there underlying motives at play?  Finally, a new device just released will help you to uncover hidden agendas and ulterior motives that may be affecting your bottom line.

Included with your order will be sample questions that experts say will uncover the darkest and deepest secrets of most fee based insurance consultants. A sample includes “Have you been promised addtional business from a vendor prior to the award of the contract?”, “Have you given our current insurance company the same opportunities that you have given the vendor that you are recommending?”, “Have you blackballed any interested vendor from competing for our business?”  “Who really did this analysis – you or the vendor you are recommending?”

We are excited about this new technology and intend to try it out soon.  If you have a test case for us, we would be happy to lend you our Truth Detector at no charge for the month of August.

You may order your very own truth detector from this website – supplies are limited so order today.

 

Enhanced Truth Detector Available for $99.95

Red Flag City

Friday, August 7th, 2009

Ever have to change TPA’s but you are not sure if the one that looks the best is really the best?  A name change three times in four years could be a red flag. An array of equity partners coming and going may cause a slight nerve twitch or tingling down your leg – maybe an inner physical warning signal that maybe things are not just quite right. Or, how about a major move from one location to another for no apparent reason? Perhaps TPA’s are nomadic by nature one could surmise. Or, is there a red flag if you find out that scores of key employees with tenure are leaving with many of the remaining sending out resumes…..and going on job interviews while out and about? How about a combination of all of these signals? Would that be a Red Flag to you?

PPO Shoot Out in South Texas

Friday, August 7th, 2009

Finally, we are going to put to rest the question that has plagued many political subdivisions in deep South Texas – Who Has the Best PPO Discounts Bar None?  A rare and unique opportunity has surfaced, exploitation of which is paramount to opening Pandora’s Box and finding a bottle with a genie in it. Only, this time the genie has more than just three wishes to grant. Mental giants have been invited to join the fun, with the promise of exposing potential solutions to the Gordian Knot of the merky and mysterious world of PPO discounts. It does not get better than this. Stay tuned Wishbone. 

                                                                                

Meritain – A New Player in Texas?

Tuesday, August 4th, 2009

Meritain may be making a move to acquire blocks of self-funded business in Texas. Rumors are rampant but unproven – http://www.meritain.com/. Cash flow problems may exaserbate the dimensions of terms of purchase to the possible advantage of the buyer. This news, along with the Viant – Multiplan Merger announced today – viant-merger may be just the beginning of some major market shifts in anticipation of Washington’s effort to implement some sort of national health plan for all Americans.

Molly Mulebrier – Contributing Editor Attempts Coup d’etat

Sunday, August 2nd, 2009

Insurgent Molley Mulebrier posted this without permission of this Blog Master. Some of these independent journalists are ballsy to the point of being annoying. We apologize to our readers. Effective Monday Ms. Mulebrier will be sent on assignment to The Congo for an extended field trip to report on the African Mud Fly and It’s Impact on Global Warming.

Another Harlingen, Texas Insurance Broker Indicted

Sunday, August 2nd, 2009

First it was Arnulfo “Half Guilty, Half Pregnant” Oliverez indicted for bribery of public officials to gain lucrative insurance contracts. Then it was Edcouch insurance agent Aaron Gonzalez  who plead guilty to a similar offense. Now it is two more insurance agents from Harlingen who are accused of selling non-existent insurance policies to Valley Baptist Medical Center.  We suppose that what makes these individuals different is that they got caught. Of course, one is guiltyonly when a confession is brokered or a jury decides their guilt.  http://www.tdi.state.tx.us/fraud/frpress.html   

                                     

Rogue Insurance Agent to Be Sentenced

Sunday, August 2nd, 2009

Arnulfo C.  “Half Pregnant” Olivarez, admitted felon, is to be sentenced in Federal Court in McAllen at 9:00 am August 14, 2009 for his crimes. At his August 2008 court appearance before Federal Judge Hinojosa, Oliverez plead guilty of charges against him but stated that he was really only half guilty. (See previous postings on this blog).

Justice, it would seem would require a prison sentence – however with the Texas Department of Insurance renewing his insurance licenses recently, it would appear some sort of deal was made in exchange for leniency.

Private, Tax Deductible Health Care in Canada?

Sunday, August 2nd, 2009

With the United States moving towards some sort of national health care plan, a careful study of health care economics and opportunities in other countries with socialized medicine in play may provide health insurance agents and third party administrators with clues as to their future role in the health care delivery system.

A Canadian TPA touts their Cost-Plus Tax Free Health Plan for Canadian citizens: www.costplus.ca