California VS Multiplan

Subject: Califoria Legal Action

Hey Guys, I wondered if you guys ( bloggers supreme ) had seen this case out of California ? Started as an action by an audit firm against Sutter Health and then the California Department jumped in. The interesting detail to me is how PHCS / MultiPlan is being treated as an “ accomplice “ due to the onerous terms of the PPO agreement ( i.e. no audit , no review ).

My opinion is that this case could be huge if it gets legs and other Departments across the country pick up on the logic. While this case is specifically applied to the anesthesia sleight of hand , could the same rationale not be applied to other areas ? How much abusive billing is covered over by the handcuffs placed on plans via PPO contract terms ? Arguably, the entire chargemaster process is driven by the incentive of “ percentage off “. Bill more get more.

CA v Multiplan  (FOR A QUICK REVIEW, READ PAGES 12-18)

Texas Political Subdivisions and Insurance Consultants

  

Dual Compensation – Hide & Seek

Many Texas political subdivisions employ licensed fee based insurance consultants to assist in the competitive procurement of insurance and on-going risk management advice. The Texas Department of Insurance issues two licenses required to act as a fee based insurance consultant in this state.

Continue reading Texas Political Subdivisions and Insurance Consultants

HB 1534 – TPA’s Can’t Comply Because PPO Networks Won’t Disclose

This is an URGENT email we received this morning:

We apologize for the late notice but we just received notice that the Texas House of Representatives Insurance Committee is meeting today starting at 1:00 and they will be voting on HB 1534. This is a bill that is aimed at the “Silent PPO” issue but has some unintended consequences that are bad for our industry.

Continue reading HB 1534 – TPA’s Can’t Comply Because PPO Networks Won’t Disclose

AMPS Introduces PEPM With Guaranteed ROI & Payer Indemnification

The Cost Plus Revolution in Texas has saved self-funded employer sponsored health plans millions of dollars (See previous postings by typing in “Cost Plus” in the search box on this page).  More Plan Sponsors are realizing that PPO discounts based off inflated medical bills through contracts that they cannot see confounds  their fiduciary duties.

Amps (www.advancedpricing.com) works with self-funded health plans. Their proven track record shows significant plan savings for their clients.

Continue reading AMPS Introduces PEPM With Guaranteed ROI & Payer Indemnification

Texas SB 1686 – Wrongfully Convicted Individuals Entitled to Group Health Insurance

“A person entitled to compensation is also entitled to group health insurance from the county in which the offense that was the subject of the wrongful conviction occurred as if the person were an employee of the county.”

http://www.legis.state.tx.us/tlodocs/82R/billtext/pdf/SB01686I.pdf#navpanes=0

Editor’s Note: If this bill passes, Texas counties may need to re-evaluate their GASB 45 liabilities.

Sixth Circuit Lifts Injunction Requiring Blue Cross to Disclose Discount Information

MyHealthGuide Source: John Eggertsen, Esq., Eggertsen Consulting, P.C., www.jhelaw.com

The U.S. Court of Appeals for the Sixth Circuit April 6 reversed an injunction that required Blue Cross Blue Shield of Michigan (BCBSM) to provide a multiemployer health fund with documents detailing BCBSM’s discount arrangements with medical providers (Pipefitters Local 636 Insurance Fund v. Blue Cross & Blue Shield of Michigan, 6th Cir., No. 09-2294, unpublished 4/6/11).

Continue reading Sixth Circuit Lifts Injunction Requiring Blue Cross to Disclose Discount Information

North Carolina Insurance Exchange – Secrecy Shrouds Contracts

North Carolina House Bill 115, legislation written by the insurance companies, would create a health benefits exchange that is neither accessible nor transparent. Remember the North Carolina State Health Plan fight? For those who need a refresher, North Carolina signed a no bid contract with Blue Cross to manage the State Health Plan. The contract was secret, not even legislators could get a copy until public pressure forced it into the open.

Continue reading North Carolina Insurance Exchange – Secrecy Shrouds Contracts

Analyzing DOL’s Review of Self Funding

On March 30, 2011, The U.S. Department of Labor issued its long-awaited report on self-insured health plans as required by the Patient Protection of Affordable Care Act.  The report focuses on self-insured group health plans – what type of employer self-insures; whether self-funded plans are financially solvent; the purpose and effectiveness of 5500 forms; the role of stop-loss; and, do self-insured group health plans truly offer less costly coverage.   The bottom line?  Continue reading Analyzing DOL’s Review of Self Funding

Federal Insurance (Welfare) Program Covers (Mandates) Pre-Existing Conditions

The federal agency Centers For Medicare & Medicaid Services is hoping to boost enrollment in a public insurance program  (welfare program) for U.S. residents who have been denied private health insurance because of pre-existing illness or disability.

In Texas, less than 1,200 have joined the new plan. Texans must be a damn healthy group of people.

Continue reading Federal Insurance (Welfare) Program Covers (Mandates) Pre-Existing Conditions