Archive for July, 2015

The Solution To Texas’ Dental Medicaid Problems

Friday, July 31st, 2015

Image result for tooth pulled out string

Grandma’s Self-Insured Dental Plan 

By Darrell Pruitt, DDS

As I read your political call for dentists to help expand Medicaid/Medicare dentalcare, currently administered by DentaQuest, it occurred to me that taxpayers deserve more transparency concerning DentaQuest – an increasingly popular but secretive destiny for tax dollars.”

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Lawsuit Claims CVS Health Overcharges for Generic Drugs

Friday, July 31st, 2015

life

Attorneys are accusing the company of deliberately inflating prices for generic drugs.

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Blue Cross To Drop Individual PPO Plans in 2016

Friday, July 31st, 2015

mulebriar“Is this more evidence managed care contracts don’t cure escalating costs or are actuaries on crack?” – Molly Mulebriar

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Doctor’s Hospital Outlines Growth Plans

Friday, July 31st, 2015

“We want to be daring and take on the biggest challenges that we can face,” he said. “We are no longer waiting for cures to come to use but we want to make that cure.”

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New Accounting Rules To Help Political Subdivisions Health Care Costs

Monday, July 27th, 2015

gasb

New government accounting rules enable local officials to get unfunded obligations to retirees under control.

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When A Bad Surgeon Is The One You Want

Monday, July 27th, 2015

numbers

“Homo sapiens have always sought redemption. Today it is through data. Numbers have replaced Yahweh and Indra. But, just like the old gods were, numbers can be moody, arbitrary and, occasionally, downright unfair. Numbers are a human construct, after all.”

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K&K Launches Student Accident Coverage Website

Sunday, July 26th, 2015

kkk

K&K Insurance Group, Inc., a subsidiary of Aon plc, has launched a new website at www.PrivateSchoolK12-kk.com offering K-12 student accident coverage. The website is designed for private, non-boarding K-12 schools and offers the ability to quote and purchase insurance online and receive coverage documents immediately via email.

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Anthem-Cigna Deal Creates Opportunity, Risk for Brokers

Sunday, July 26th, 2015

streesed

Stressed Heath Insurance Broker Contemplates Future

“Brokers that are comfortable working on a fee-basis will be fine, but the majority of small and mid-size brokers still work on a commission basis, so this could be a real risk for them if they do not have the skill set or culture in their organization to engage clients on a fee-basis,” O’Connor says.

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Michael Turpin Nails It – Post Merger Market Place & Role of Brokers

Sunday, July 26th, 2015

TURPIN “The only hope is more hospitals/health systems take-risk based contracts as accountable care organizations and fill the national void with myriad local fee standing health plans who can give the remaining national carriers a run for their money and keep competition alive.”

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The Affordable Consolidation Act Moves the Insurance Market From an Oligopoly to a Duopoly

Sunday, July 26th, 2015

duopoly Only massive bureaucracies with huge compliance and legal departments are equipped to deal with the approximately 40,000 pages of the Patient Protection and Affordable Care Act’s laws and regulations.  It is crushing competition.

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Nevada School District to Settle Insurance Broker Suit for $1.65M

Sunday, July 26th, 2015

clarkThe Clark County School District in Nevada says it will pay a former insurance broker $1.65 million to settle a lawsuit that claimed the public agency ended the broker’s contract prematurely.

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Greece’s Costly Health Care Craze

Sunday, July 26th, 2015

envelope

Every stakeholder was benefiting from the system, except one: the patient. In addition to the official costs of care and drugs, there was another price people had to pay: a fee known as “the envelope.”

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Rio Grande Valley Medical Center Gains National Accreditation

Friday, July 24th, 2015

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EDINBURG – The Commission on Cancer of the American College of Surgeons granted three-year accreditation to the Doctors Hospital at Renaissance cancer program.

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Anthem-Cigna Deal Could Come Today

Thursday, July 23rd, 2015

anthem

Report: Anthem-Cigna Deal Could Come Today

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The Case of The Missing Tooth

Thursday, July 23rd, 2015

missingtooth

“The VA is funded with millions of dollars and billions of dollars but you will not pay providers? How is it the veteran’s fault that you are such an incompetent part of the United States government?” – Fred Rendon

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Assurant Self-Funded Business Sold To National General

Tuesday, July 21st, 2015

nationalgeneralNational General (rated A- by AM Best) has purchased Assurant’s block of self-funded business and will now provide marketing, actuary, and underwriting services.

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PPACA Exchange Plans Offer Less Choice of Doctors Than Commercial Plans

Tuesday, July 21st, 2015

kidding

Summary: The only way insurance companies can compete for business on the PPACA exchange is through lower rates. That is accomplished by paying providers less. Benefit design is mandated and therefore not a differentiator in plan selection.

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Sierra-Berkshire Associates Inc.

Monday, July 20th, 2015

riskassesmentSierra-Berkshire Associates, Inc. is a Nevada corporation, incorporated in February, 1996. The company’s main office is located in Reno, Nevada. Principal Associates are also located in Las Vegas, NV and in the Hartford, CT area.

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DHR Hopes To Double In Size – Competitors Whine

Sunday, July 19th, 2015

whine

DHR hopes to double size, but faces opposition from other local hospitals

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Xerox, Eastman Kodak And Cost Plus Insurance

Saturday, July 18th, 2015

trojan

Remember Xerox? How about Eastman Kodak? Both companies were pioneers in their industries. They were visionaries providing solutions by fulfilling previously unmet needs, creating new markets that did not exist before.

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Pros and Cons of Using Reference-based Pricing

Friday, July 17th, 2015

tellme

“Traditional models rely on a non-transparent contracting process in which insurance companies negotiate discounts off of over-inflated charges.”

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Brownsville ISD Seeks Health Insurance Proposals

Thursday, July 16th, 2015

bisd

Brownsville Independent School District (BISD) is seeking proposals for administration of the district’s self-funded employee health plan. BISD is currently with Blue Cross.

http://www.bisd.us/Purchasing/html/Solicitations.htm

Blue Cross Private Exchange Announces New Enhancements

Thursday, July 16th, 2015

hcsc

Chicago, IL, July 16, 2015 — Health Care Service Corporation (HCSC), the nation’s largest non-investor-owned health insurer, today announced several enhancements to its Blue Directions private exchange solution for large employers, available now for the upcoming 2016 benefit plan year.

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Children’s Hospital Of San Antonio Joins BCBS Network

Tuesday, July 14th, 2015

childrenhospBaylor College of Medicine, the academic partner for Children’s Hospital of San Antonio, has reached an agreement with Blue Cross and Blue Shield of Texas to participate in the insurer’s PPO plan.

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More Evidence Manage Care Doesn’t Work

Tuesday, July 14th, 2015

tissue1

Premiums are spiking around the country. Obama is in denial.

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Brownsville Doctor Fined $75,000

Sunday, July 12th, 2015

tdiBrownsville doctor has an extensive disciplinary record with the Texas Medical Board, agency public records show.

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Are Health Care Networks Going To Jurassic Park?

Friday, July 10th, 2015

jurassic

Charging a fee for access to a group of health care providers has been a fantastic business. Low investment in capital assets, minimal labor costs and bountiful cash flows attract our country’s smartest investors. With margins above 60 percent, it is no surprise the Goldman Sachs of the world own networks.”

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An Analysis of Popular Legal Arguments Against Price Transparency

Friday, July 10th, 2015

mfnIn health care provider-insurer contracts, three types of clauses inhibit price transparency: (1) non-disclosure agreements, or “gag clauses;” (2) anti-tiering/anti-steering clauses; and (3) most favored nation clauses.

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Anthem, Cigna Progressing Toward Deal: CNBC

Friday, July 10th, 2015

ego

(Reuters) – Health insurers Anthem Inc (ANTM.N) and Cigna Corp (CI.N) were moving ahead to sign a merger deal as Cigna backed down on its differences over governance issues, CNBC tweeted, citing sources. TRANSLATION: Ego’s at play in the boardroom

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Study Shows Free Stuff Costs Less

Wednesday, July 8th, 2015

freestuffNew York Times reports that out-of-pocket spending on “most major birth control methods fell sharply in the months after the Affordable Care Act began requiring insurance plans to cover contraception at no cost…………….

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New Opportunity For Insurance Agents?

Tuesday, July 7th, 2015

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Phia Group – Claim Negotiation & Sign Off – Case Study

Tuesday, July 7th, 2015

PHIA

“The provider, as is the case with many, initially told us that it was not interested in negotiating at all….”

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The Employer-Led Health Care Revolution

Tuesday, July 7th, 2015

americanrevolution

Intel was rigorously managing its equipment suppliers but not its health care suppliers…….Intel decided it  could use its purchasing power in markets where it had operations to influence health care players—care providers, health plan administrators or insurers, and other employers—to rise above their competing self-interests and work together to redesign the local health care system….

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Assuring Hospital Emergency Care Without Crippling Competition

Tuesday, July 7th, 2015

emergencyroom

“Emergency departments are often more profitable than hospitals admit, as they are the source for roughly half of inpatient admissions. Patients admitted in emergency situations are rarely price-conscious, and revenue from ED admissions is often counted as part of subsequent inpatient stays. Furthermore, as non-urgent cases presenting in the ED are often relatively cheap to treat and well-covered by ED reimbursement rates, hospitals lack the incentive to redirect them to cheaper sites of service.”

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Appropriate Use Of Reference Pricing Can Increase Value

Tuesday, July 7th, 2015

reference“The U.S. Department of Health and Human Services has interpreted reference pricing as consistent with the principles of the Affordable Care Act when implemented by large, self-insured employers, and has adopted a salutary wait-and-see stance.”

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Insurance Companies Blame Actuarys

Sunday, July 5th, 2015

odds1

Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected.

Upon hearing the news, hordes of actuarys flock to liquor stores throughout the fruited plane seeking solace……………..“An actuary is a person who passes as an expert on the basis of a prolific ability to produce an infinite variety of incomprehensible figures calculated with micro-metric precision from the vaguest of assumptions based on debatable evidence drawn from inclusive data derived by persons of questionable reliability for the sole purpose of confusing an already hopelessly befuddled group of persons who never read the statistics anyway.”    

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Anonymous Responds To BISD vs HealthSmart Settlement Terms

Sunday, July 5th, 2015

gorilla1The perception that BISD was screwed by HealthSmart over so called provider “pricing discounts” demonstrates common ignorance. This is understandable since the general public has no understanding whatsoever how our health care delivery system is structured.

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Aetna To Buy Humana

Friday, July 3rd, 2015

price

Aetna buys Humana for $37B amid record number of health care deals

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High-Deductible Plans – Hospital Bad Debt & 75% Lower Utilization

Wednesday, July 1st, 2015

chasingdollarsHigh deductible plans are creating new headaches for hospitals, including more unpaid bills and seasonal demand for some healthcare services as patients wait to hit their deductibles before seeking non-urgent care.

The bulk of the savings through high deductible plans, up to 75%, come from lower utilization. It’s not the value of the increased deductible per se, it’s the change in behavior. When it’s other people’s money it doesn’t matter, but when it’s your money it’s a completely different dynamic.

Instead of jacking up prices, hospitals should work with local health plans to achieve equitable solutions – lower reimbursement rates for lower deductibles and co-insurance. Is 250% of Medicare and chasing dollars better than 100% of Medicare and not chasing dollars?

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