Archive for August, 2012

San Benito School Superintendent Investigates Insurance Emails

Thursday, August 30th, 2012

SAN BENITO — Superintendent Antonio Limon said Wednesday that he is conducting an internal investigation that focuses on an exchange of emails about the district’s insurance carrier.

Limon declined to disclose the names of the persons who exchanged the emails.

On May 16, a district memo stated that school board President Yliana Rodriguez announced that Robert Champion Jr. and the Salazar Insurance Group would handle the school district’s $8 million health insurance business.

Two days later, Rodriguez rescinded the action before the Texas Education Agency told the district that she failed to obtain the school board’s approval to hire the insurance carriers.

Limon fired longtime risk manager Janie Gonzalez on Aug. 24, but declined to say why.

Board member Oscar Medrano said Gonzalez told him that Rodriguez told her to write the memo.

Gonzalez has declined to comment, and Rodriguez has refused to say whether she told Gonzalez to write the memo.

Limon said he discovered the e-mail exchange as a result of a public records request for the messages, but he would not say if these e-mails are the same as those requested by the Valley Morning Star.

The Star on Aug. 24 submitted an open records request for e-mails between Gonzalez and Rodriguez; district insurance consultant Glenn Hillyer; district purchasing agent Adrian Garcia; Robert Champion Jr.; Robert Champion Sr.; and the Salazar Insurance Group and Joe Salazar.

School attorney Scott McDonald, an attorney with the Austin law firm of Kevin O’Hanlon, refused on Wednesday to release the e-mails that Limon had readily available, but said the e-mails would be released today.

http://sbnewspaper.com/?p=7952

fernandodv@valleystar.com

 

Health Systems Get In The Insurance Business

Thursday, August 30th, 2012

Some hospital networks are cutting out the middle man and becoming insurers, themselves, Kaiser Health News reported. As a growing response to flat-rate payments for care rather than the traditional fee for service, hospital chains are making the move to change their business model.
(more…)

Locking Up The Market in 54 Minutes

Wednesday, August 29th, 2012

Insurance agents compete for business with other agents. Insurance companies usually honor proposal requests on a first come, first served basis. Below is a redacted email we received yesterday which we believe may illustrate how an agent will and can  “lock up” the market before his competitors can do so. Note the times of the emails:

 

From: Insurance Agent Jones
Sent: Monday, August 20, 2012 03:32 PM
To: ‘aetna’ <largegrouprfp@aetna.com>; ‘BCBS’ <bcbssanantoniorfp@bcbstx.com>; ‘BMA’ <gsaenz@bmatpa.com>; ‘Boon Chapman’ <info@boonchapman.com>; ‘Caprock Health’ <dkoch@caprockhp.com>; ‘EBS’ <olivia@ebsincorporated.com>; ‘GPA’ <mattm@gpatpa.com>; ‘Great West’ <catherine.bishop@gwl.com>; ‘Healthsmart’ <jennifer.smith@healthsmart.com>; ‘Humana’ <jgasper@humana.com>; Jennifer L Henry; ‘Providence Admin’ <kferguson@pristx.com>; ‘trustmark’ <james.murphy@trustmarklife.com>; ‘UMR’ <aaron_r_daniels@uhc.com>
Subject: FW: Inurance Proposals Packet

Please let me know if you will offer a proposal on this group.

Thanks

Insurance Agent Jones

 


From: HR Director of ABC Company
Sent: Thursday, August 16, 2012 2:38 PM
To: Insurance Agent Jones
Subject: Inurance Proposals Packet

Mr. Jones,

I have attached the following information for the Insurance Proposal for our facility. Please contact me if there is anything else needed.

Thanks,

Happy HR Director of ABC Company

Editor’s Note: Agents who successfully lock up the market in a competitive bid situation effectively controls the bid process. Prior to submitting his bids, the agent knows the contents of each bid and can play favorites if so inclined. “Hey buddy, your competitor, XYZ Insurance Company is 5% lower than your quote, you need to drop your rates 10% and add another $20,000 in commissions.”

From an insurance broker:

What is telling about this are the email addresses used. I can tell you some are addressed to people who no longer work for the carrier contacted. One in particular left over a year ago. The other email addresses are general box email addresses anyone can get off the internet. This agent is shotgunning the market to lock it up.

From Harvey the Rabbit:

It’s not 54 minutes. It’s more like 4 days and 54 minutes. But I get the point.

 

Employers Find New Ways To Cut Health Costs

Monday, August 27th, 2012

As health care costs continue to increase, employers are looking for ways to cut costs, such as reducing spouse and dependent coverage in 2013, says a study out today.

Milliman Seeks Health Insurance Consultant for Dallas Office

Monday, August 27th, 2012

The Health & Group Benefits Consultant is an integral part of the overall client management and client relationship function in the Southern Employee Benefits region. Focus will be on developing and growing the Health & Group Benefits practice by effectively building, growing and maintaining client relationships.

(more…)

RTA Corpus Christi Seeks Competitive Proposals For Group Health Insurance

Monday, August 27th, 2012

http://ccrta.org/rta-business/

San Benito ISD Insurance Mess – Citizens Outraged

Sunday, August 26th, 2012

http://sbnewspaper.com/?p=7900

ObamaCare And The Medicaid Gold Rush

Sunday, August 26th, 2012

“Medicaid is about as far from a normal business as one can imagine. It is the emergency room for our worst chronic social problems. Illiteracy, drug addiction, broken families, migrant labor, illegal immigration, teen pregnancy – you name it, and Medicaid gets to deal with it.”

(more…)

San Benito ISD: Direct Contracts or PPO Rental Network under Private Label?

Wednesday, August 22nd, 2012

Is the San Benito Independent School District really seeking direct contracts with medical providers or simply accessing an existing PPO rental network on a private label basis? For clues, watch the last 15 minutes of this insurance workshop video:

http://www.youtube.com/watch?v=TPN9aHZ1PuI&feature=youtube_gdata_player

We have recieved quite a few emails on the posting immediately preceding this one, from all parts of the country. San Benito ISD has sparked a lot of interest in the brokerage/consulting community – a fascinating case study.

Prior Postings on San Benito ISD: http://blog.riskmanagers.us/?p=8986, http://blog.riskmanagers.us/?p=9019, http://blog.riskmanagers.us/?p=9046, http://blog.riskmanagers.us/?p=9064

From an actuary firm:

Bill, I watched the entire video. My God! Did you get the part about the TPA not charging anything until they get a claim? They are working off a percentage of savings! Who is their actuary?

From a reinsurance broker:

The first 58 minutes is more entertaining than the last 15 minutes. Consultant lacks polish. Board lacks brains.  We wouldnt put up with either up here.

 

San Benito ISD Insurance Work Shop Produces Headaches

Tuesday, August 21st, 2012

http://www.youtube.com/watch?v=TPN9aHZ1PuI&feature=youtube_gdata_player

Editor’s Note: Also see http://www.youtube.com/watch?v=6RiES1JQFZA&feature=youtube_gdata_player

San Benito ISD Embarks Upon On Bold Experiment

Tuesday, August 21st, 2012

The San Benito Independent School District is seeking proposals for TPA services to administer an alternate plan of benefits utilizing direct provider contracts. The intention is to offer this plan as an alternative option to their existing Blue Cross PPO plan.  To that end, San Benito ISD will, in effect,  have two plan administrators, Blue Cross and a yet to be named TPA.

We know of no school district in Texas that offers separate health insurance plans using different plan administrators. We suspect that the purpose of doing so revolve around access to  PPO negotiated rates.

Blue Cross maintains their own proprietary provider network, available only to their customers. As far as we know, Blue Cross does not rent out their network to competitiors, at least not at this time. Their biggest selling point, often rehearsed by salaried sales representatives in competitive situations, is their purported “deep provider discounts that no other competitor can touch”

Unfortunately, it is nearly impossible to prove Blue Cross’s claim of superior discounts in the aggregate. Conversely, on a case by case basis, it is easy to prove that the opposite is true. Thus is the world of secretive and manlipulative PPO contracting.

Based upon the San Benito RFP seeking TPA services to administer the district’s direct provider contracts, two conclusions are forthcoming: (1). San Benito ISD has determined that their direct contracts are better than those contracts BCBS has negotiated and (2). San Benito ISD can control health care costs by aggressive steerage through their on-site clinic referrals.

The RFP indicates lower costs and better benefits for those employees who select the Alternate plan, “Managed Care Plan”  (See San Benito Health Benefits ).  This can only be calculated through empiricle data. An actuarial study (by a licensed, independent actuary) would be well advised although we have no information whether such an exercise was performed in this instance.  Nevertheless, our assumption must be that San Benito ISD has performed their due delligence to determine the cost basis and risk involved in formulating this alternate set of benefits, taking into account provider discount differentials between BCBS and the district’s negotiated rates, as well as the impact of the on-site clinic and controlled referrals.

San Benito ISD is not the first South Texas school district to move away from third party negotiated provider contracts.  The Rio Hondo and La Feria Independent School Districts cancelled their PPO agreements in 2011 and instead negotiated direct contracts with willing area providers. Over 400 local physicians have agreed to their pricing model for example. Plan savings have proven significant.

Numerous examples of provider savings realized by Rio Hondo and La Feria ISD, include MRI’s for $300 instead of $2,500 or more through various PPO contracts. Hospital contract/s based on Medicare RBRVS as a benchmark in lieu of discounts off arbitrary, inflated billed charges.

Other South Texas school districts should take note. Rio Hondo, La Feria, and now San Benito school districts are taking a proactive approach to reigning in their health care costs using proven and prudent business practices.

Editor’s Note: The key to the San Benito business plan is their on-site medical clinic. Direct contracting in conjunction with on-site medical care is a powerful weapon in controlling runaway medical costs.  We applaud San Benito ISD for their efforts.

From a Mid-West Insurance Consultant:

Bill, Just so you know, BCBS does allow some TPAs to pay claims that use their networks. This happens with labor unions. However, the Blues re-price the claims and the TPA pays the re-priced claims without ever seeing the billed charges. They make sure no one knows the real discounts.

 

 

Earnest Fiduciaries Increasingly Rely On Consultants

Monday, August 20th, 2012
The simple truth is that it is no longer “reasonable” for plan sponsors to avoid having specialists assisting them in dealing with their benefit plans.
(more…)

Medical Stop Loss Insurance & Captives – The Dammit Moment

Saturday, August 18th, 2012

“We’re totally focused on the employer of 50 to 500 people who has had what we call the ‘Dammit!’ moment”, Andrew explains. “That occurs when the employer says, ‘Dammit, I’m not paying another ten percent premium increase without being able to see our experience data or have control of our coverage.”

(more…)

Cost-Plus Stop Loss Policy

Saturday, August 18th, 2012

Seeking fronting carrier to issue cost-plus stop loss policies for existing block of business.  Must be filed with the Texas Department of Insurance. Contact RiskManager@sbcglobal.net.

http://blog.riskmanagers.us/wp-content/uploads/2011/04/Cost-Plus-Stop-Loss-Insurance.pdf

San Benito ISD Seeks TPA Proposals

Friday, August 17th, 2012

San Benito Independent School District is seeking competitive proposals for TPA services:

“The school district is formulating an additional health care plan option for the employees. This additional option is a managed care plan. The school district will be utilizing their own direct contracting rates. This plan will provide additional cost savings to the school district  and provide an affordable option to access health care for the employees. Please see the attached schedule of benefits on the proposed managed care plan. This new proposed plan will require the services of a Third Party Administrator to provide traditional services and the additional requirements of the school district, in order to implement the execution of the new plan.”

SBCISD RFP

Editor’s Note:  The current plan administrator is Blue Cross whose PPO network is proprietary. Will Blue Cross be able to meet the specifications? Will current stop loss cover be affected should another plan through another administrator be implemented?  Or will the current stop loss carrier agree to cover the risk? How will interested stop loss carriers be able to quote on this proposed separate plan without knowing who will be on it, and the risk to be assumed? Will competing stop loss carriers necessarily want the entire risk to be assumed, on both plans? Why would San Benito want to employ two TPA’s to administer their self-funded health plan?  What direct contracts have already been negotiated and by whom? Are these direct contracts better than those negotiated by Blue Cross? Are these contracts available through an Open Records Request? Will the current Blue Cross  contract with the district allow the district to offer a competing plan or is that contractually prohibited? Has San Benito employed an insurance consultant to assist in this RFP process?

San Benito ISD may be on to something here – taking control and managing costs.

Reinsurance Fees To Hit Self-Funded Health Plans in 16 Months

Thursday, August 16th, 2012

As employers tackle health care reform’s cost and compliance issues, a new fee slated to apply to insurers and third-party administrators from 2014 to 2016 is raising concerns. The fee will fund a temporary reinsurance program to help stabilize insurance premiums against the impact of covering individuals with high claims costs. Some projections estimate that this fee could run from $60 to $100 per covered individual. However, many details needed for reliable estimates remain unknown.

Blue Cross Gearing Up For Expected Boom In Individual Health Insurance Sales

Thursday, August 16th, 2012

“…… in just two years, the individual market could grow to 15 million people, according to eHealthInsurance.com, which operates private exchanges. Because most people are unaware of the individual health insurance market, “these retail outlets will create a lot of visibility and credibility for individually sold policies,” eHealthinsurance spokesman Nate Purpura told News-Press.

(more…)

Starmark Announces Self-Funded Health Plan For Small Groups

Wednesday, August 15th, 2012

“Employers like you often struggle to find healthcare benefits options that give you the control, flexibility and value you need – until now. With HealthyEdge, you get better control over your health benefits, the flexibility to tailor your self-funded plan design to your specific needs, and the opportunity to receive a refund if your group’s claims are lower than expected.”

http://www.starmarkinc.com/email/starmark/T500-97.html

Editor’s Note: Health insurance carriers will transform their fully-insured business to self-funded administration in response to ObamaCare. TPA’s may find this a new niche market – small employer groups of 10 employees or more. Stop loss retention as low as $10,000 will be in demand.

Small Employers Move To Self-Funded Plans – Avoids PPACA Reform Measures

Wednesday, August 15th, 2012

“The insurance companies have found a way around the [Affordable Care Act],” especially in states likePennsylvaniawhere the stop-loss market is largely unregulated, saidTimothy Jost, health law professor at theWashington and Lee Universitylaw school.

(more…)

San Benito ISD Insurance Consultant In Hot Water

Tuesday, August 14th, 2012

SAN BENITO — School board member Oscar Medrano wants the superintendent to fire an insurance consulutant who would not name the company that would insure the district. Medrano and board member Anna Cruz on Monday said they had learned that the Salazar Insurance Group was the company that offered the insurance plan that consultant Glenn Hillyer recommended without naming.

(more…)

NAIC Delays Vote On Model Law Raising Stop Loss Attachement Points

Tuesday, August 14th, 2012

A proposal to raise specific attachment points in a stop-loss model act to a level that proponents of self-funding say would restrict smaller firms’ ability to self-insure health benefits was delayed after an Aug. 11 debate hosted by the National Association of Insurance Commissioner’s ERISA working group. The working group cited the need to study the proposal further.

(more…)

Feds Consider Scrapping “Use It of Lose It” FSA Provision

Tuesday, August 14th, 2012

A little-noticed bulletin from the Treasury Department could have a big impact on the roughly 155 million Americans who use flexible spending accounts to cover out-of-pocket health care expenses.

(more…)

Allstate Solicits Agent/Owners

Monday, August 13th, 2012
Dear Texas Producers:The Allstate Insurance Company is currently looking for successful Life, Accident and Health Agents, Property and Casualty Agents and/or Securities licensed individuals in Texas who would be interested in buying an existing, local Allstate agency in Texas. This is an opportunity to own a nationally recognized branded business with ZERO franchise fees.

There are several requirements that you must meet in order to qualify.
We are looking for candidates who:• Have an entrepreneurial spirit and the desire and ability to run their own business. • Have at least $50,000 in liquid capital to invest. • Are willing to work hard to achieve goals and represent the company. • The appropriate licenses or the ability to pass the applicable licensing exams.

If however, this is not the right opportunity for you, and you are aware of a great person we would be anxious to talk to anyone you can refer us. (We are willing to pay a nice referral fee if they are appointed.*)
We look forward to talk with you or someone in your network to discuss the Exclusive Agent opportunity. Please call Luvorise “LV” Dahlman (214)843-2508 to learn more. You can also email LuVorise.Dahlman@allstate.com

All inquiries will remain confidential.
Sincerely,
LuVorise “LV” Dahlman, Texas Sr. Regional Recruitment Consultant 214.843.2508
Allstate Insurance Company is an Equal Opportunity Company
This is a professional communication for individuals affiliated with the insurance and financial industries. We do not want any agents or advisors to receive these emails unwillingly. Please use the link below to be removed from all future mailings. 

ObamaCare Glitch Lowers Federal Subsidies

Monday, August 13th, 2012

Under the proposed rules, health insurance provided by an employer is considered not affordable if a worker pays of premium of more than 9.5 percent of the worker’s household income. The Internal Revenue Service says this calculation should be based solely on the cost of individual coverage for the employee and not coverage of a spouse or children.

(more…)

Creative Claim Settling

Sunday, August 12th, 2012

In one case, he worked with a claimant who was reluctant to accept a $50,000 settlement.In conversations with the worker and his attorney, the man mentioned that his dream was to spend his time fishing for bass in Oregon. Mr. Gitter used that information to offer the worker a $38,000 bass fishing boat plus about $8,000 in cash.The worker accepted the offer almost immediately, he said.“

(more…)

Pre-Existing Condition Health Plan Enrollment By State

Sunday, August 12th, 2012

http://www.healthcare.gov/news/factsheets/2012/08/pcip08102012a.

 

 

Ryan Eviscerates ObamaCare In 6 Minute Video

Sunday, August 12th, 2012

http://www.youtube.com/watch?v=zPxMZ1WdINs&feature=youtube_gdata_player

Text Of Comments From Employers and TPAs To NAIC – Stop Loss Insurance Model Act

Friday, August 10th, 2012

http://www.naic.org/documents/committees_b_erisa_1208_concerns_employers_tpas.pdf

Another Failure In The Making – Health Insurance Exchanges

Friday, August 10th, 2012

From time to time we have chronicled the various failures of the Affordable Care Act (ObamaCare), and they are many.

(more…)

Papa John’s to Raise The Price Of Pizza Due To ObamaCare

Thursday, August 9th, 2012

WASHINGTON (CBSDC) — Papa John’s warns it will have to raise the price of its pizzas due to President Obama’s health care law.

John Schnatter, CEO and founder of Papa John’s, said pizza will cost up to 14 cents more when the Affordable Care Act goes into effect in 2014.

“We’re not supportive of Obamacare, like most businesses in our industry. But our business model and unit economics are about as ideal as you can get for a food company to absorb Obamacare,” Schnatter said in a conference call during last week’s shareholder’s meeting, according to Politico.

Schnatter later added: “If Obamacare is in fact not repealed, we will find tactics to shallow out any Obamacare costs and core strategies to pass that cost onto consumers in order to protect our shareholders best interests,”

According to Pizza Marketplace, there are nearly 4,000 Papa John’s restaurants in all 50 states and 33 countries.

Schnatter, a Romney supporter, held a private fundraiser for the GOP presidential candidate at his Kentucky home in April.

Editor’s Note: Guess who will be paying for ObamaCare? It won’t be employers.

TRS ActiveCare And ObamaCare

Wednesday, August 8th, 2012

In 2001 the state of Texas passed a bill authorizing the establishment of a group medical program for Texas public school districts. The program is called TRS ActiveCare. Thus was established a single payer government plan for Texas school employees.

There may be a similarity between the Texas TRS ActiveCare plan and ObamaCare in the sense that plan sponsors may find certain advantages to terminating their existing plan and joining government sponsored health plans instead.

I remember vividly my conversation with a school superintendent when the TRS ActiveCare plan was passed by the Texas legislature.

When I asked him if his district was going to join the government plan, his response was immediate and forceful:

“Yes, of course. I would be an idiot not to join TRS ActiveCare! Just think Bill, no more insurance committee meetings, no more dealings with damn insurance salesman, no more dealing with employee complaints about their insurance. All I will have to do in that case is tell them to call Austin and complain to their state representative. This gets us out of the insurance business and allows us to focus on what we do best – teach!”

Most Texas school districts have terminated their group medical plans and have joined the Texas government single payer health plan funded, in large part,  by taxpayers.

On a side note, Governor Perry says he is against ObamaCare. Yet his own state, under his watch,  established a single payer medical plan that competes with private health plans.

ObamaCare may have the same effect. Plan sponsors face increasingly stringent government mandates. They are at risk. Texas House Bill 300 for example, to take effect September 1, 2012 , directly puts a plan sponsor at risk for HIPPA violations. Fines and sanctions are significant. Federal laws have similar consequences.

Why would an employer want to continue sponsoring a medical plan when the liabilities involved could put them out of business? And why would they want the headaches too?

Editor’s Note: The Perry jab is intentional. In our opinion, the only difference between Republicans and Democrats is that Republicans take longer to get there (except in Mass. where RomneyCare was implemented way before Obama was a household name). Remember Medicare in 1966? More Republicans than Democrats were against it ( http://www.ssa.gov/history/tally65.html ). Now Republicans are 100% in support of it. Will Republicans, given time, overwhelmingly support ObamaCare too? If you are against something based on principle, and you  subsequently change  your opinion in favor of it, what changed?

NAIC August 11, 2012 Meeting – Will Self-Funding Survive?

Wednesday, August 8th, 2012

“The proposed revisions to the Stop Loss Insurance Model Act will severely limit small employers’ ability to self-fund and guardagainst the financial impact of unexpected and catastrophic claims. Self-funded arrangements coupled with the protection of stoploss protection offer a viable option for small employers who voluntarily choose to self-fund health insurance coverage for theiremployees. In today’s healthcare environment, policymakers should be promoting choice, transparency, affordability, andwellness opportunities rather than eliminating the very products that achieve these goals.”

http://www.naic.org/documents/committees_b_erisa_1208_agenda_materials.pdf

Effective September 1, 2012, New Texas Health Care Law More Stringent Than HIPPA

Tuesday, August 7th, 2012

The new law contains severe civil penalties for violations of the law. Penalties can range from $5,000 up to $1.5 million per year for unlawful disclosure of a patient’s PHI.

(more…)

Lessons From MinuteClinic

Tuesday, August 7th, 2012

After entering the clinic a thought occurred to me: why do we need doctors? Then a second thought: why do we need nurses? Ah, but I’m getting ahead of myself.

(more…)

Rx Rebates To Pay For Free Contraceptives?

Monday, August 6th, 2012

Plan Administrators Need to Identify all Responsibilities and Liabilities of Contraception Coverage Mandate

www.siia.org

With today being the start date for plans to begin providing contraception coverage to plan participants, it’s important that all administrators of self-insured, “exempted” plans be fully-aware of what their responsibilities and liabilities are in such situations. As part of the PPACA, plans are mandated to cover preventative services on a first-dollar basis. Regulators recently released guidance stating that contraception coverage is to be considered a preventative service in regards to this provision. Earlier this year, the Administration released a Proposed Rule which granted exemptions to certain religious-based organizations from having to provide such coverage as part of their plan; however, participants in these plans would still be able to receive such services.  The Rule stipulated that for participants in exempted plans whose sponsors fully-insure their coverage, the financial obligation would be levied on the fully-insured carrier.  For participants of exempted plans whose sponsor self-insures, the Rule obligates TPAs to provide the coverage.

Specifically, the TPA for a plan sponsored by an exempted entity is responsible for covering the cost of the mandated contraception coverage.  The TPA is not permitted to bill the plan, but the Rule lays out certain funding sources a TPA may use to provide the coverage, including; drug rebates, service fees or credits against mandated fees.  The Rule also would allow a TPA to separately arrange contraception coverage through an insurer.

At each stage of the rule-making process, SIIA’s Government Relations Staff has communicated with senior regulators as to the many practical and legal problems such a requirement on TPAs would have.  Staff has also been invited to meet with a number of high-level Capitol Hill policy-makers and was even requested to draft a talking points paper on the areas we identified as problematic.

As part of our officially submitted comments on the subject, SIIA classified a number of reasons why this requirement on TPAs is unworkable.  First, that coverage of contraception services by the TPA would be constituted as a prohibited transaction under ERISA as it would not be approved by the plan-sponsor. Also highlighted is that TPAs may not use any secured rebates to fund the services as the rebates belong directly to the plan-sponsor and not to the TPA. Lastly, that a TPA is limited to plan administration and not claims payment.

While SIIA will continue to lobby the relevant Agencies as to the many problems this mandate will have for TPAs, as of today, all plan administrators who provide services to exempted plan-sponsors must be acutely aware of what their responsibilities and liabilities are.  For further details about the Rule’s specific provisions or for help with interpretation, please contact Jay Fahrer, SIIA’s Director of Government Relations at 202-463-8161 or jfahrer@siia.org.

From a PBM:


I saw this last week when SIIA sent it out.  What a crock of crap.  The administration is applying the same mentality often used by their uneducated constituents.  “It won’t cost me anything, the ‘government’ will pay for it.”  In this case the ‘government’ is saying “it won’t cost the religious institution anything, the TPA will pay for it”.  That is completely illogical!  I’m curious why they didn’t just say that the drug/device manufacturer will provide their products free of charge for religious institutions.  If a drug/device is consumed/used, somebody has to pay for it.  The biggest ‘winner’ in this whole deal is pharma.

Buying Toothpaste Versus Buying Health Care

Sunday, August 5th, 2012

A trip to the local CVS store to buy toothpaste today was instructive of how differently we approach the cost of healthcare.

Since I do not have toothpaste insurance, this shopping trip was on my dime. So with that in mind, I found the aisle marked Dental Care. As I navigated through the confusing and complicated world of toothpaste, I started at the top of the shelf – Wow what a selection! A few of the brands were familiar, probably due to toothpaste commercials  viewed throughout the years. One 6 oz product was $7.45 but it promised sparkling white teeth, winning smile and good breath for hours. Others, same 6 oz size, were lower in price, averaging $2.50 to $4.50 for  6 oz supply.

On the very bottom shelf, towards the end of the toothpaste area, was a 6 oz toothpaste marked at 99 cents. Sensing that at such a low price, this must be an inferior product I compared the active ingredients,. All brands had one in common: sodium fluoride at 0.24%.  Each brand noted that sodium fluoride as “anticavity toothpaste.”

Further scrutiny brought added comfort that the lowest priced product was probably the best buy. “Value Pack, 30% more product on sizes up to 4.6 oz” , and there was a note that the product was “ADA Accepted – American Dental Association”.  But what cinched the deal was the printed representation that the product “cleans, freshens and protects”, all for 99 cents.

With local sales tax, AIM toothpaste cost  $1.08 versus  $4.86 for Colgate, an astounding 77% savings. Taxes were only 8 cents compared to 36 cents for Colgate, an even more astounding savings of 450% in taxes.

If I had toothpaste insurance with a low co-pay, I would probably have choosen Colgate.

ObamaCare Minimum Loss Ratio Requirement To Be Extended To Hospitals

Sunday, August 5th, 2012

In a rare Sunday press conference, President Obama announced that effective January 1, 2013 hospitals must abide by new minimum loss ratio rules. “Hospitals and their insurance partners are getting rich off the backs of poor working Americans. It’s time to take action. Effective January 1, 2013 I have directed that a new policy be implemented to make hospitals accountable to the American people.”

“As you know, my health care bill makes insurance companies accountable. Instead of making enormous profits off the pain and suffering of struggling Americans seeking health care, my bill makes it mandatory for insurance companies to rebate most, if not all of their profits to the masses. Many have already received their rebates so please remember who got those for you in November. There is more to come, trust me. Hospitals should be treated no different. It’s only fair that we ask, no we must demand, that hospitals share in this national effort to lower health care costs. It’s only right. We are all in this together, and together we will achieve universal health care, even for Republicans. ”

Editor’s Note: Obamacare continues to evolve as confusion reigns. Final rules have yet to be promulgated. Plan Sponsors are stressed.

 

 

 

 

Surgical Center Advertises Transparent, Direct Pricing

Friday, August 3rd, 2012

If you have a high deductible or are part of a self-insured plan at a large company, you owe it to yourself or your business to take a look at our facility and pricing which is listed on this site.  If you are considering a trip to a foreign country to have your surgery, you should look here first.  Finally, if you have no insurance at all, this facility will provide quality and pricing that we believe are unmatched.

It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system.   Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive.  As more and more patients find themselves paying more and more out of pocket, it is clear that something must change.  We believe that a  very different approach is necessary, one involving transparent and direct pricing.

www.surgerycenterok.com

PEBA Announces Hospital Audit Program

Wednesday, August 1st, 2012

PEBA Audit Alliance Alert 2012

Editor’s Note: Since most Texas political subdivisions offer employees managed care plans, i.e, PPO plans, we wonder how receptive PPO networks will be towards this PEBA endorsement? Reading a PPO contract is probably a good idea for those considering this audit offer. They may find they have given up their audit rights.

Mean Uncaring Insurance Companies Root Of Health Care Crisis

Wednesday, August 1st, 2012

In a statement released by a high ranking Obama administration official last week, many may find it obvious that the root of our health care crisis in this country lies squarely on the back of greedy, uncaring, profiteeriing insurance companies.

Health and Human Services Secretary Kathleen Sebelius said in a news conference Tuesday, “For too long insurance companies have stacked the deck against women, forcing us to pay more for coverage that didn’t meet our needs.”

The federal government, to protect us from greedy profiteering and uncaring insurance companies have mandated that profits must be shared with the masses. This mandate, better known as the Minimum Loss Ratio requirement, makes it nearly impossible for an insurance company to make a profit off the backs of hard working Americans who otherwise could not pay the exhorbitant fees charged by hospitals and doctors.

“It grates against all moral fiber to see greedy insurance companies make a profit off the pain and suffering of sick Americans whom many would otherwise die an early death due to lack of financial resources that prolong the lifestyles of hospital administrators and other kind and giving health care providers who are also our neighbors” said Don Pedro.

“The government now needs to sanction gas station owners against the high price of oil! The government needs to take over all the gas stations in the United States and dictate lower gas prices!” It’s the new American way of conducting business” said Hugo Chavez in a statement released yesterday from his hospital bed in Havana.

 

 

How Should Employers Handle Medical Loss Ratio Rebates?

Wednesday, August 1st, 2012

If you are fortunate enough to receive an MLR rebate, follow the road map provided by the DOL in Technical Release 2011-04 to make sure you handle the rebate correctly.

(more…)

Employee Benefits Developments July 2012 – Rulings & Opinions

Wednesday, August 1st, 2012

Agencies Issue New FAQs Regarding Summary of Benefits and Coverage

The U.S. Departments of Labor, Health and Human Services and the Treasury have issued a set of frequently asked questions (FAQs) regarding the implementation of the Patient Protection and Affordable Care Act. This recent guidance, the ninth in a series of FAQs that the agencies have published, focuses on the summary of benefits and coverage (SBC). The SBC is a new document that group health plans and insurance issuers will be required to provide to plan participants regarding their benefits. Below is a summary of some of the issues addressed by the recent guidance.

(more…)

HSA Enrollment Keeps Growing

Wednesday, August 1st, 2012

AHIP’s latest census of HSA-qualifying insurance coverage contains some fascinating information. Keep in mind these numbers are for HSA-qualifying coverage only. It does not include HRA plans or stand-alone high deductibles.

The finding reported in most of the news stories is that enrollment in these plans grew from 11.4 million in January 2011 to 13.5 million in January 2012, an increase on 18% in one year.

This continues the steady growth documented by AHIP’s annual surveys. The trend line is unmistakable –

(more…)

Employers Move To Adapt To ObamaCare

Wednesday, August 1st, 2012

Two major provisions of the health-overhaul law take effect Wednesday, testing employers’ ability to adapt to changes the measure mandates.

(more…)