“In our healthcare system, the “middleman” is not who you think………… In reality, it is the physician who has become a “middleman” in the healthcare transaction or, as I argued, a subcontractor to the insurer.”
Month: October 2015
Many Need to Shop Around on HealthCare.gov as Prices Jump, U.S. Says
GOVERNMENT SPIN DOCTOR ON CRACK: “The Affordable Care Act has created a dynamic, competitive marketplace, with considerable choice and affordable premiums in 2016.”
Continue reading Many Need to Shop Around on HealthCare.gov as Prices Jump, U.S. Says
Health Care Cost Discrimination – Not All Prices Are Equal
“If you want the $6,221 MRI, you should have it — but you should pay for it, not me, not my employer, not my government. If you want the $300 test, it’s yours. If you want to buy your prescription for $150, go ahead. But you should also know that if you walk two blocks, you can get it for $17. (Yes, these are real numbers.)”
Editor’s Comment: The following article is a good one. It clearly shows the convoluted pricing of health care in this country. It also brings up a valid issue: health cost discrimination in health care. Health insurance is a reimbursement benefit. Members incur medical expenses, and are then reimbursed (never mind Assignment of Benefits – all that is extended credit by providers). So why should a plan sponsor reimburse employee Jones $3000 for an MRI and only reimburse employee Smith $400 for the same exact medical procedure? That is discrimination of the worst kind…………..
“Not all prices are equal in health care” – Molly Mulebriar
Continue reading Health Care Cost Discrimination – Not All Prices Are Equal
ObamaCare is Falling Apart
Trident Public Risk Solutions
Trident Public Risk Solutions (Trident) strives to be the preeminent specialty commercial insurance provider for public entities. From small municipalities who need first-dollar coverage to larger public entity risks that require unique funding and reinsurance mechanisms, Trident is your single-source platform for public-sector risk management solutions.
Cadillac Tax – Controlling Behavior
Free Market Lesson – Former Hedge Fund Manager Faces Competition
Ex-Hedge Fund Manager Who Jacked Up Price of Drug by 5,000 Percent Gets Lesson in Free-Market Capitalism
Continue reading Free Market Lesson – Former Hedge Fund Manager Faces Competition
Puerto Rico Looks To Organ Transplant Business To Cure Ailing Economy
“Puerto Rico’s potential as a transplant center is partly based on a macabre statistic – the Caribbean island had a murder and non-negligent manslaughter rate of 19.2 per 100,000 people in 2014 compared to 4.5 per 100,000 in the United States………….”
Continue reading Puerto Rico Looks To Organ Transplant Business To Cure Ailing Economy
Protection Money Staves Off Balance Billing
“We all know that the average American health care consumer seldom have the money to pay their own health insurance deductibles and co-insurance, especially now that health plans are gravitating to higher deductibles and out-of-pocket exposure. Paying these expenses is difficult enough, much less balance bills” – Molly Mulebriar
Continue reading Protection Money Staves Off Balance Billing
Drug Politics – A Bipartisan Issue?
“Psst, we should get in the prescription drug business Godfather!”
Drug politics go Republican as Rubio criticizes industry
Oct 20, 2015 | By Drew Armstrong and Sahil Kapur
(Bloomberg) — Republican presidential candidate Marco Rubio joined the debate over U.S. drug prices, saying in a speech last week that some practices by the industry amounted to “pure profiteering.”
Amazing Rx Cash Pricing Differencials For Lantanaprost
Lantanprost average retail pharmacy cost $6
Retail Cash Prices:
HEB – $90
Walgreens – $76
Independent Pharmacy – $18
Cash paying customers see this and act accordingly. Those with insurance see only a small co-pay and don’t give a damn
From a Doctor:
Check this out – www.healthwarehouse.com/latanoprost-0-005-opthalmic-solution-1.html
From a PBM:
You are right on it. I looked up our MAC for Latanoprost with NDC 17478-0625-12. Our current MAC effective for October is $3.58085 per unit and the bottle contains 2.5 units which mean ingredient cost would be $8.95. Pretty good reference based pricing, huh.
WHITE HOUSE TURNS TO THREATS AS OBAMACARE ENROLLMENTS STALL
Now that ObamaCare is failing in the exact way its critics predicted more than 5 years ago, the White House is preparing to use threats to increase ObamaCare enrollment numbers next year. The threat, of course, is the ObamaCare tax.
Continue reading WHITE HOUSE TURNS TO THREATS AS OBAMACARE ENROLLMENTS STALL
No Ready-Made Rx For Rising Drug Costs
When Turing Pharmaceuticals raised the price of an older generic drug by more than 5,000 percent last month, the move sparked a public outcry. How, critics wondered, could a firm charge $13.50 a pill for a treatment for a parasitic infection one day and $750 the next?
Aetna and Humana Merger A Bad Deal For Texas, Physicians Warn
“……if Aetna and Humana are allowed to merge, the new company would gain control of 36 percent of Texas’ health insurance market……..physician groups especially could be negatively affected by a merger as they could end up with “very little negotiating leverage to allow them to secure favorable pricing terms.”
Continue reading Aetna and Humana Merger A Bad Deal For Texas, Physicians Warn
Stories Causing Atlas To Shrug
Dumb Consumers Protected Against Evil Balance Billing
Dumb American health care consumers need big government to protect against evil balance billing by greedy health care providers. The government of New York is doing something about it……………
Continue reading Dumb Consumers Protected Against Evil Balance Billing
Four Reasons Drugs Are Expensive, Of Which Two Are False
“North Korea and the drug industry are the last bastions of Marxism”
Continue reading Four Reasons Drugs Are Expensive, Of Which Two Are False
What’s Driving Healthcare Spending? It’s the Drugs, Stupid!
“This latest health care spending growth report is more proof that astronomical prescription drug pricing continues to send health care spending higher and higher for consumers, public programs and our economy”
Continue reading What’s Driving Healthcare Spending? It’s the Drugs, Stupid!
New Study Confirms Some Women Are Charged More Than Other Women
New study reveals that some women pay more for health care services than other women. Identical health care services range for some women as much as 76 times more than for other women.
Continue reading New Study Confirms Some Women Are Charged More Than Other Women
Measuring Change
QUESTION: How do we know we are doing much better this year than last year?
ANSWER: What was this year is last year plus or minus this year’s changes.
If change is the only constant why do we need to measure it? You don’t know if something is better if you didn’t now how to measure what it was before.
Source: Unknown
HIPPA Audits To Begin
Source: DK Pruitt
“United States: OCR Confirms HIPAA Audits To Begin in Early 2016 – Forced to respond to a stinging audit report recently released by the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) that found less than effective enforcement of the HIPAA privacy standards, HHS’s Office for Civil Rights (OCR) will commence its long-awaited HIPAA audits in early 2016.” By James E. Bowers for Mondaq, October 9, 2015
“EHRs provide long-term savings, convenience.” (No byline, ADA News, December 6, 2013).
The 16 Most Absurd ICD-10 Codes
Sucked into a jet engine, survived, then sucked in again? First of all, that really, really sucks. Second of all, this patient is obviously Wolverine, and should be detained for imaging and posterity.
Forest Park Medical Center San Antonio Property Owner Files Bankruptcy
“….the filing was attributed, at least in part, to financing challenges and insurance company curtailment of payments to facilities that have traditionally operated as out-of-network providers….”
Continue reading Forest Park Medical Center San Antonio Property Owner Files Bankruptcy
Take Command Health, Zane Benefits Partner to Serve Small Businesses in Texas
Take Command Health, a Texas-based startup dedicated to helping individuals choose and save on their health insurance, is partnering with Zane Benefits to provide Texas businesses with fewer than 50 employees with health benefits products and services.
Continue reading Take Command Health, Zane Benefits Partner to Serve Small Businesses in Texas
McAllen Independent School District Seeks Insurance Consultant
Patient Protection? Who is the Boogie Man in the Room?
By Dr. Alan Preston
“Who is the boogie man in healthcare? I am going to look at three possible culprits as to cost drivers of healthcare…”
Continue reading Patient Protection? Who is the Boogie Man in the Room?
Harlandale ISD Questions Land Deal – Quid Pro Quo?
“He bought a waterfront home near Rockport from the CEO of an insurance company that does business with the district. Diane Mullen is competing to win contracts worth more than a million dollars.”
“Madrigal recommended board members choose her, but did not disclose he had done personal business with her.”
Continue reading Harlandale ISD Questions Land Deal – Quid Pro Quo?
Sierra-Berkshire Associates, Inc.
Medical Community Will Compete For Business If Given The Opportunity
In 1999 several large progressive-thinking employers approached GM&A because they felt victimized by the increasingly hyper-expensive healthcare industry. They wanted to know if we could help arrest the growth of soaring medical expenditures.
Continue reading Medical Community Will Compete For Business If Given The Opportunity
Hidalgo County Seeks Insurance Consultant
Hidalgo County approves RFP process for professional consulting services for the Hidalgo County Self-Funded Health & Welfare plan.
Government Asks Supreme Court For Contraceptive Mandate Ruling
Continue reading Government Asks Supreme Court For Contraceptive Mandate Ruling
Asserta – A Better Way To Pay For Healthcare
Asserta Health provides enabling infrastructure for “cash” health plans that deliver significant cost savings by eliminating the “value drain” associated with the typical payment process. The entire healthcare transaction is simplified, transparent, and supported by a service model that effectively frees clinical and financial resources to focus on improving the cost, quality, and efficiency of the care itself. The result is a better healthcare experience—and outcome—for the consumer, the provider and the payer.
Continue reading Asserta – A Better Way To Pay For Healthcare
Associated Builders & Contractors Announce Medical Plan For Members
AUSTIN, Texas, October 1, 2015 — Associated Builders and Contractors (ABC) and Fringe Benefit Group today announced the expansion of The Contractors Plan, a benefits platform designed specifically for construction contractors, to include a full suite of benefits including ACA-compliant major medical, dental, vision, life, disability, retirement and HRA plans – all managed through a single online platform.
Continue reading Associated Builders & Contractors Announce Medical Plan For Members
School Superintendent’s Land Deal With Insurance Agent Draws Scrutiny
“There needs to be some kind of investigation, that way there is transparency at Harlandale,” says Julie Gimbel, President of the Harlandale Educational Association, the union which represents teachers.
Continue reading School Superintendent’s Land Deal With Insurance Agent Draws Scrutiny
Thanks ObamaCare!
I just got the first year bill from my payroll company for the extra reporting we have to do each year vis a vis Obamacare: $7195.50 for 2015. Note that this adds absolutely no value — this is not the cost of insurance or cost of any extra taxes sent to Uncle Sam. This is merely the cost to handle all the new paperwork required in the law.
I will repeat what I have said before — the Republicans tend to focus narrowly on taxes and often tend to miss or downplay the regulatory issues, which I think actually loom larger in destroying economic growth.
Source: coyoteblog.com