Archive for April, 2015

What Uber Drivers Can Teach Health Care

Thursday, April 30th, 2015

uber

“When I asked him what he thought of this, his response was a resounding “Hell no!” and he said he would find something else to do if this ever happened.”

“While doctors may be losing the battle for autonomy, I hope that the enterprising and fiercely independent Uber drivers never do.”

(more…)

Assurant To Quit Medical Market

Wednesday, April 29th, 2015

goodby

“Insurance giant Assurant is looking to sell its health insurance division……. Regardless if a buyer is found, it will pull out of the health insurance marketplace by 2016…”

(more…)

Continental Benefits

Wednesday, April 29th, 2015

continentalWouldn’t it be a relief to find a partner that can help you successfully navigate the health care system?

(more…)

Montvale Surgical Center v. New Jersey Health Benefits Commission

Wednesday, April 29th, 2015

onesixtyThe issue in this case was whether a New Jersey government agency should pay an ambulatory surgical center out-of-network health care benefits at 160% of the Medicare rate, rather than, as required by statute, a rate determined by a “nationally recognized database.”

“There are very few market forces that limit what an out-of-network provider can charge. For that reason, non-participating providers are often reimbursed significantly more than their in-network counterparts.”

(more…)

Do Fee Based Consultants Earn Kickbacks From Carriers They Recommend?

Sunday, April 26th, 2015

kickback111

One of the best kept secrets of the insurance industry is the practice of paying kickbacks to insurance consultants which are never disclosed to clients who pay them.

(more…)

Insurance Agent Found Guilty of Racketeering and Money Laundering

Sunday, April 26th, 2015

Randall Petersen

Operating under multiple business names, Randall Petersen, 49, conducted a fraudulent insurance scheme that involved his theft of several hundred thousand dollars of commissions and bonuses from American National Insurance Company and Liberty National Insurance Company.

(more…)

Wellness Programs & Global Warming

Thursday, April 23rd, 2015

gore

Wellness programs are popular these days. Who wouldn’t be against healthier lifestyles? But according to this study exercise does not help in reducing obesity. Eating less does. The myth follows the same pattern as the global warming myth – both are politically correct but scientifically flawed – Molly Mulebriar

(more…)

Fugitive Ends 40 Years On The Run To Get Healthcare

Thursday, April 23rd, 2015

fugitive Moore before and after

A fugitive in Kentucky has turned himself in to authorities after decades on the run, so he can get medical care.

(more…)

Medical Consolidation Continues In San Antonio

Thursday, April 23rd, 2015

(more…)

Brownsville Blogger Investigates BISD vs HealthSmart Settlement Terms

Wednesday, April 22nd, 2015

ham

 

Suing a Ham Sandwich has never been easier, especially in Brownsville, Texas. All is needed is $150 for the filing fee………….

EL RRUN RRUN: BISD TRIES TO KEEP LID ON MULTIMILLION HEALTHSMART SUIT

Need A Second Opinion On Your Self-funded Medical Plan?

Wednesday, April 22nd, 2015
riskmanager.us
If you wish to continue operating your self-funded plan the old fashion way this post will not be of interest to you……….

(more…)

Texas House Bill 3453 – A Flicker of Life?

Tuesday, April 21st, 2015
trsactivecare
Texas House Bill 3453 (H.B. No. 3453), if passed, will allow participating school districts to exit the program. Currently they are prohibited from leaving. 

(more…)

88-Year-Old Mississippi Doctor to Continue Practicing From His Car

Tuesday, April 21st, 2015

old doctor

By Jeff Amy | April 20, 2015

An 88-year-old Mississippi physician, who has faced scrutiny because he was practicing medicine from his car, said after a meeting with regulators that he now expects to be able to continue seeing patients.

(more…)

Cost Plus Insurance: New Reality In Provider Payment Models

Sunday, April 19th, 2015

cost plusProviders across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans……….Given their growing popularity, Providers need to be proactive in understanding and managing these types of programs.

(more…)

Was There Health Insurance In 1912?

Saturday, April 18th, 2015

Theodore Roosevelt. Click image to expand.

“Roosevelt’s Progressives were the first major American party to pick up the baton of health care reform”

(more…)

Republicans Surrender

Saturday, April 18th, 2015

surrender

The only difference between Democrats and Republicans is Republicans take longer to get there. Remember Medicare in 1966? Republicans opposed it, now they support it. Standing up for one’s principles is a fleeting, temporary and convenient emotion in politics” – Don Pedro

(more…)

Six Ways AMPS Is The Leader In Price Transparency

Friday, April 17th, 2015

aaaaa “We have been on a RBR/Cost Plus platform for five years. We changed to AMPS several years ago and highly recommend them. AMPS provides a quality product at a competitive price” – E. Juarez

(more…)

It’s Cheaper To Fly Your Employee To Europe for their Appendectomy

Thursday, April 16th, 2015

germanbeer34

 

John, der irrt! Deutsch Bier und deutschen Frauen sind die besten!

“There are plenty of reasons to brag about living in America, like the fact that we have the most innovative beers on the planet (sorry Germany)”

(more…)

Will Accountable Care For Medicaid Work In The Ghetto?

Thursday, April 16th, 2015

smoker121

Patients might only be able to get to a doctor during the day on the weekends because it’s too dangerous in the neighborhood to be going out at night……The patient goes to the pharmacy but is told the new medication requires pre-approval.  The patient doesn’t know what to do so the patient goes to smoke a cigarette…………...

(more…)

Free Market Healthcare Whole Foods Style

Wednesday, April 15th, 2015

wholeWhole Foods CEO John Mackey argued in the pages of the Wall Street Journal that the solution to America’s health care crisis was to be found in “less government control and more individual empowerment.”

(more…)

Methodist Healthcare Strikes Deal With Eagle Ford Shale hospital

Wednesday, April 15th, 2015

pakman

San Antonio’s Methodist Healthcare System has entered into an agreement with the Frio Hospital District Board of Directors and will take over administration and management of Frio Regional Hospital in Pearsall in the Eagle Ford Shale area.

(more…)

Are You Ready For Your Department Of Labor Audit?

Wednesday, April 15th, 2015

dol

DOL has ramped up its audit efforts on health plans.  And  now the audits include requests for documentation based on Health Reform (PPACA).  Could you come up with this list of 30 items DOL Audit

ERISA – Fiduciary Duty: Proposed Exemption to Engaging In “Self Dealing”

Tuesday, April 14th, 2015

erisa

” The exemption allows fiduciaries to receive compensation when plans and IRAs enter into certain insurance and mutual fund transactions recommended by the fiduciaries as well as certain related transactions.”

(more…)

San Antonio Runs Off Uber, Now Texas Uberizes Telemedicine?

Tuesday, April 14th, 2015

seriously

The City of San Antonio, through punitive restrictions on free trade has run off Uber from the city effective April 1. Now the State of Texas, through special interests, runs off telemedicine companies too? What has happened to traditional Texan values of hard work, innovation and freedom to conduct commerce?

(more…)

Interesting Trivia for Insurance Consultant Nurds

Tuesday, April 14th, 2015

mulebriarA study for a large group we manage is quite interesting. Over a three year period average hospital billed charges (Chargemaster Rates) have increased 27%  while our costs have increased 2%.

(more…)

Reference Based Reimbursement: What is required to do it right!

Tuesday, April 14th, 2015

aaaaa“RBR/Cost Plus offers employers the opportunity to lower healthcare charges by 30% or more and will soon dominate the healthcare landscape replacing the current PPO system that often grossly overpays hospitals and physicians.”

(more…)

Connecticut Fee Schedule for Hospitals, ASCs Takes Effect

Tuesday, April 14th, 2015

really

Connecticut’s Medicare-based fee schedule for workers’ compensation takes effect April 1.

The new fee schedule pays 174% of Medicare for in-patient care, 210% outpatient care and 195% for ambulatory surgical centers.

This is touted as a cost savings measure. Does this mean prior to April 1 Connecticut hospitals and ambulatory centers were getting more?

So much for managed care contracts these days and another reason why Cost Plus Insurance, Medicare Plus reimbursement schemes are taking the market by storm. Payers are “mad as hell and not taking it anymore……” – Homer G. Farnsworth, M.D.

(more…)

SWBC Executive Expands Consulting Group to Austin

Tuesday, April 14th, 2015

swbc

SWBC is expanding its Employee Benefits Consulting Group into the Austin and Central Texas market.

(more…)

Top health insurance CEO pay exceeds $10 million in 2014

Tuesday, April 14th, 2015

greedy

“The CEOs of the Big Five for-profit health insurance companies all took home at least $10 million in 2014, according to each insurers’ annual filings with the Securities and Exchange Commission (SEC).”

(more…)

Why the Private Health Insurance Industry Has to Go

Tuesday, April 14th, 2015

tissue1

“…….the time has come for us to replace private health insurers with a more efficient, not-for-profit single-payer financing system–national health insurance (NHI)–which could be enacted by passage of H. R. 676, Expanded and Improved Medicare for All.”

(more…)

Hospitals and Prescription Drugs Leading Health Spending Acceleration

Tuesday, April 14th, 2015

mad

“Prescription drugs grew the fastest, by 10.5%, and hospital spending also rose rapidly at 9.0%.”

(more…)

Defined Contribution Rx Plan – What A Novel Idea!

Friday, April 10th, 2015

SimpleSaveRx is the first 100% defined contribution, 100% transparent PCM and it is the exact opposite of PBMs today.

(more…)

Here Is What Happened On January 1, 2015

Friday, April 10th, 2015

broccoli1Elections have consequences. ObamaCare, with John Robert’s blessing, is a tax. Although Congress can’t mandate everyone must buy broccoli they can sure tax you if you don’t.

(more…)

Health Insurance Brokerage: Lowest Pricing Drives Sales in Fully Insured Market

Thursday, April 9th, 2015

carsalesman

By Homer G. Farnsworth

Does it matter how good you service a fully-insured account, or how long you have had it? Under the PPACA the answer is “probably no.” Low price has become the determining factor between success or failure in retention of business in today’s fully-insured market.

Most brokers remaining in the fully-insured market live or die on rates alone.

(more…)

Allstate Wins $46 Million Judgement In RICO Suit Over Health Claims

Thursday, April 9th, 2015

child

By Kurt Orzeck

Law360, New York (April 08, 2015, 9:35 PM ET) — A New York federal court on Wednesday entered a $45.7 million default judgment in favor of Allstate Insurance Co. and other insurance companies in their Racketeer Influenced and Corrupt Organizations Act suit alleging a vast money-laundering conspiracy to bill for fraudulent health claims.

(more…)

San Benito ISD Struggles To Fund Health Care Plan

Thursday, April 9th, 2015

actuary1

The San Benito Independent School District’s self-funded health plan is in the red. Unexpected rise in health care expenditures have the school trustees searching for a solution.

(more…)

Rx Copay: Daddy’s Credit Card

Wednesday, April 8th, 2015

creditDrug costs are skyrocketing and account for as much as 25% of total health care spend for plan sponsors. Most plans continue to cover prescription drugs through an antiquated system established years ago when drugs were relatively inexpensive.

(more…)

San Antonio Runs Off Uber, Now Texas Runs Off Telemedicine Companies?

Tuesday, April 7th, 2015

(more…)

High Health Care Utilization and Rabbits

Sunday, April 5th, 2015

rabbitRomeo & Juliet on Wedding Day

Health care costs increase when utilization does……..

(more…)

What’s In Your Hospital Bill – Actual Examples Found By Audit Firm

Sunday, April 5th, 2015

 

Employers, Cover Your Assets: Employee Contributions Leave You at Risk

Friday, April 3rd, 2015

Employers, Cover Your Assets: Employee Contributions Leave You at Risk

Hear this: If you are a self-funded employer or third-party administrator and you don’t have anyone looking at detailed facility claims you are jeopardizing your business.

(more…)

Employer Announces New Santa Claus Qualified Health Plan For Employees

Friday, April 3rd, 2015

Image result for here comes santa claus

“Dear Employee: As you may be aware, Santa Claus has passed a law to help us get affordable health insurance……”

(more…)

Garland ISD Employee Clinic Holds Grand Opening

Friday, April 3rd, 2015

 

With healthcare costs on the rise, Garland ISD aspired to create an affordable and convenient resource for its employees. After months of planning, construction and fine-tuning, the GISD Employee Clinic opened Wednesday, April 1.

(more…)

AXIS Acquires Ternian Insurance Group LLC

Thursday, April 2nd, 2015

 

 

AXIS LOGO 2

We are excited to announce that AXIS has acquired Ternian Insurance Group, LLC, a leading provider of voluntary, limited benefit, affordable health plans and other employee benefits coverage for hourly and part-time workers and their families.

(more…)

Former Benefit Consultant Offers Innovative Partnership Opportunity

Thursday, April 2nd, 2015

Benefitsally

We partner with innovative benefit consultants and employers to bring intelligent healthcare solutions to the table. These solutions are cost-cutting opportunities for mid-sized companies – regardless of industry – that are easily implemented into existing benefit plans.  http://www.benefitsally.com

(more…)

San Benito ISD Rejects TRS ActiveCare – Seeks Insurance Consultant

Thursday, April 2nd, 2015

freddy

San Benito – Home of Baldemar Garza Huerta (Freddy Fender)

In a special called school board meeting (http://board.sbcisd.net/wp-content/uploads/2015/03/s033015.pdf ) on March 30 the San Benito Independent School District rejected the administration’s recommendation to join the TRS ActiveCare plan.

(more…)

TPA Earns Undisclosed Fees Through Marked Up Hospital Bills?

Thursday, April 2nd, 2015

hide

“these administrative fees were concealed in marked-up hospital claims and “no longer visible” to its customers because they falsely appeared to be money owed to hospitals “

(more…)

RiskManagers.us Wins Insurance Contract

Wednesday, April 1st, 2015

shakinghands1

San Antonio, Texas  RiskManagers.us, a specialty company in the benefits market that works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods has been awarded a $10,000,000 insurance contract by the City of San Antonio.

“We are pleased to make this announcement today and look forward to a long and rewarding relationship with the City of San Antonio,” stated company spokeswomen Molly Mulebriar.

(more…)