Archive for September, 2014
Tomorrow Benefit Mall will announce a new benefit plan administered by Assured Benefit Administrators, an El Paso based TPA. Combining a MEC plan with concierge medicine, with attractive broker commissions, we expect this product to do well in the Texas market.
Santa Monica, Calif.-based advocacy group Consumer Watchdog has filed lawsuits against health insurers Cigna and Blue Shield of California alleging the companies misled consumers about the size of their networks, according to a Kaiser Health News report.
SOLUTION: DROP PPO NETWORKS AND PAY ALL PROVIDERS THE SAME (That’s what we have been doing for 7 years – RiskManagers.us)
Instead of saving the district money, the company increased the amount of money the district would have spent, he said, adding that the consulting firm was not providing the services outlined in the contract. “I think it is time to move forward,” he said. “I would like to get a service without having to pay $50,000 for it.”
(See Insurance Consultant Steals Food From Children – Will San Benito replace consultant with this one?)
Waco Independent School District officials are looking to join with the city — which could expand its private clinic to provide more preventive care — in an effort to drive down the district’s health insurance costs.
While the big carriers who often are administrators of self-funded plans claim to have their client’s interests at heart, they shun from their network the highest quality and lowest priced players in the market, my facility being a classic example. Part of the reason for this is the massive revenue generated by selling their “discounts” or repricing of claims, the carriers claiming as their own, a percentage of the “savings” they have generated for their clients.
With this arrangement the last thing the carriers want is to seek out reasonably priced care, particularly from a transparently priced facility, as the absence of any claims adjudication eliminates their repricing opportunity and revenue.
Uncle Sam, the Working Man’s Partner, is gonna be some kind of pissed at tax time.
Health plans and providers often use gag clauses in their agreements and prohibit self-insured employers from using claims data for price transparency. Neither insurers nor providers want competitors and other customers to know what they are willing to settle for. However, states are increasingly outlawing gag clauses in healthcare contracts.
If your clients had a hard time finding an on exchange plan that included the doctors and hospitals that they prefer, you may be able to offer a solution during this open enrollment!
PLUS – if you were frustrated with getting paid during the last OEP…
We offer a 9 Month Advancefor on exchange business!
- Competitive Rates
- The widest network
- Great Commissions
- 9 month Advance
- Fantastic Agent Training and Service
CALL NOW! 1-800-544-8250 ext. 120 Or visit us online at www.stephens-matthews.com
“In May of this year, Peugh received a call from her mother, stating that Patricia Bazaldua had taken out a $5,000 loan in August 2012, she stated in her affidavit. She called the insurance company, requested a copy of the application and found someone forged her and her husband’s names…………..Mario Bazaldua Sr. told police there were two withdrawals from his annuity without his permission.”
“Some of the advocates of reference pricing seem to imply that reference pricing will increase competition between providers …If a monopolist faces no competition, reference pricing cannot create an incentive for it to lower its price for fear that business will be lost to competitors.
No More Election-Lock for Cafeteria Plans with Non-Calendar Plan Years
“There are six important things for employer-sponsors to note:
 The cafeteria plan is permitted to rely upon the employee’s representation of intent to enroll in a Marketplace plan … (actual proof of enrollment is not required).
 The employer-sponsored cafeteria plan document must be amended to allow for such a mid-year election change….
 In no event under this guidance may a cafeteria plan allow a participant to revoke a coverage election on a retroactive basis.
 Mid-year election changes under this guidance are permitted, but not required.
 This guidance does not extend to health FSA elections.
6] As long as the employee is still eligible for the employer-sponsored coverage (assuming it is affordable and of minimum value), the employee will not be eligible for tax credits in the Marketplace
(Hill, Chesson & Woody)
UCs have sent a warning shot to primary care practices, but they didn’t, and can’t replace them.
“It is what it is, nothing more, nothing less….”
Source: Mintz Levin
A recent Washington Post article (“Glitch in health care law allows employers to offer substandard insurance,” September 12, 2014) highlights an Affordable Care Act compliance strategy being marketed heavily (and adopted widely) in industries that traditionally did not previously offer coverage to large cohorts of variable hour and contingent workers. (We discussed these arrangements in a previous post. The strategy—which is referred to commercially as a “minimum value plan” or “MVP”— involves an offer of group health plan coverage that, while similar in most respects to traditional major medical coverage, carves out inpatient hospital services.
“Whether these plans were “intended,” or whether they are consistent with Obamacare, is irrelevant”.
A Cleveland, Ohio law firm, representing hospitals, offers advice to clients on how to respond to the “challenge” of Cost Plus Insurance plans http://www.swohfma.org/pdfs/RESPONDING-TO-THE-CHALLENGE-OF-CUSTOM-DESIGN-BENEFIT.pdf
– Interesting and another reason to hate sleazy lawyers – MD
-The strategy he is recommending is not about collecting/recovering the money from employees, it is about causing enough pain for employees that anger and dissatisfaction directed towards the employer creates enough pressure to cause the company to pay and, ultimately, to abandon a “true cost” plan design. – RH
According to the new survey results, eight out of ten (81 percent) physicians describe themselves as either over-extended or at full capacity, while only 19 percent indicate they have time to see more patients. In fact, 13 percent of physicians no longer accept Medicare patients – this is up 49 percent in 2014 from 2012.
PreferredOne, the insurer that sold nearly 60 percent of all private health plans on Minnesota’s Obamacare exchange, on Tuesday said it would leave that marketplace
A South Texas Insurance / Investment broker has gained new school district clients using competitive investment options through 457 plans. In the past several months three large South Texas school districts have expanded their retirement options to include a 457 plan along side their traditional 403b plan. Fees are a competitive 35 basis points. These districts include Brownsville ISD, Donna ISD and the San Benito ISD, totaling over 12,000 employee lives.
At Ternian Insurance Group, we always consult with our own ACA experts as well as those in the industry before recommending any particular solution. As the buzz around one approach has increased—the carve out of essential benefits using a “loophole” in the CMS essential value calculator—we have approached this idea with a healthy amount of skepticism.
A flaw in the federal calculator for certifying that insurance meets the health law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits such as hospitalization coverage, according to brokers and consultants.
John Keenan, who built his Torrance-based insurance business into one of the largest privately held brokerage and consulting firms in the country while stressing “people before profits,” has died. He was 84.
How to fight an outrageous hospital bill in 10 easy steps. First: Be a doctor or nurse. Then learn about upcoming….OR BETTER YET, SEND THE CLAIM TO AMPS
Editor’s Note: This Wall Street Journal article was sent to us by our friends at AMPS
The Brownsville Independent School District Board of Trustees voted unanimously last night to continue with Blue Cross on a new three year contract. This is the first time in living memory that the BISD has kept the same third party administrator for more than three years at a time. Usually changes are made with each school board election and sometimes even sooner.
Common belief in the insurance world is if you get the BISD account, you are good for a maximum of three years. The BISD +$50 million honey pot draws fierce competition from brokers, agents, TPA’s, carriers, PBM’s, PPO’s and ancillary third party intermediaries.
Competition is good for taxpayers.
During the best & final offer period of the RFP Blue Cross came in with aggressive fixed costs. In addition the BISD insurance consultant went through a re-pricing analysis and found BCBS has “the best discounts”, followed by United HealthCare whose discounts represented an estimated +$4 million higher cost over BCBS for the year according to the consultant.
A postmortem analysis of all proposals received by the BISD would be fascinating.
Among school districts BCBS remains the dominant force in the Lower Rio Grande Valley as well as other political subdivisions such as Cameron and Hidalgo County. La Joya Independent School District Board of Trustees voted recently to go with BCBS for plan year 2014-15.
Since 90% of health plan costs are claims, and since many experts believe BCBS has the lowest and best pricing contracts with the provider community, it is a wonder why BCBS does not have 100% of the business, 100% of the time.
American Risk offers innovative risk transfer strategies employing out-of-the-box solutions