Month: November 2015
Games Brokers Play
“Those who have data win. Those who have good data win a lot. Those who have real time data win all the time.”
The Phenomenon of Balance Billing Under PPACA
“Balance billing is representative of the last throes of a failed health care delivery system.”
Continue reading The Phenomenon of Balance Billing Under PPACA
RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, 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.
ObamaCare’s Fate Depends On Aetna / Anthem
The fate of Barack Obama’s signature health-care law may depend on how long Anthem Inc. and Aetna Inc. are willing to wait before starting to make money off it.
“Exiting the exchange market would likely indicate that the entire marketplace experiment has failed….”
Tower Watson Sweetens Willis Merger Offer
Willis is seeking Towers Watson to better compete with larger insurance brokers……..
Colorado To Vote On Single Payer Health Care in 2016
If passed, the new system would be financed by a 10 percent payroll tax hike.………This comes three years after voters approved a ballot initiative that made Colorado the first state to legalize recreational marijuana………
Continue reading Colorado To Vote On Single Payer Health Care in 2016
Obama-Scare: Biggest US Health Insurer Might Leave Exchanges
The nation’s largest health insurer fired a shot across the bow of ObamaCare on Thursday, citing flagging enrollment and high-risk customers in suggesting it may have to pull out of the exchanges in 2017.
Continue reading Obama-Scare: Biggest US Health Insurer Might Leave Exchanges
Continental Benefits – Fast Growing National TPA
More Evidence of The Failure of PPO’s
Medicare Plus vs High Value PPO Network
Increasing pressure from rising medical costs and the looming Cadillac Tax are pushing employers to consider innovative options to manage their Health Plans.
Court Case Shows How Health Insurers Rip Off You And Your Employer
“The hidden fees were listed in internal BCBSM documents under a variety of names: provider network fees, contingency/risk fees, retiree surcharges, and—my personal favorite—other-than-group subsidy fees………………Lest you think this scheme was something BCBSM dreamed up on its own, an actuary from the consulting firm Milliman Inc. testified under oath that many other insurers engaged in the same practices.”
Continue reading Court Case Shows How Health Insurers Rip Off You And Your Employer
The Hangover That Led To The Discovery of Ibuprofen
Dr Stewart Adams knew he had found a potential new painkiller when it cured his hangover ahead of an important speech.
Continue reading The Hangover That Led To The Discovery of Ibuprofen
Donna ISD Mystery Indictment – Who Is Person “A” – Law Firm or Insurance Company?
“The unnamed businessman was told that if he wanted his company to keep a contract with the school district that Infante and Yanez must be paid $10,000 each, the indictment alleges. “
Continue reading Donna ISD Mystery Indictment – Who Is Person “A” – Law Firm or Insurance Company?
I Am Retiring!
Good Morning Martha,
I AM RETIRING!! Today is my last day at work. My official day of retirement will be January 1, 2016.
I just wanted to say thanks for the many years you and Bill have helped me do my job. When a situation arise and I was in doubt as to how help my co-workers with questions about their claims or insurance coverage, I knew all I had to do was to contact one of you and the situation was taken care. I will miss you. Take care and hope you’ll have happy holidays coming up and a very happy New Year!
Jesse
Doctors Seek to Block Two Health Insurance Mergers
The American Medical Association asked U.S. antitrust regulators to block two proposed mergers that could reshape the health insurance industry.
Continue reading Doctors Seek to Block Two Health Insurance Mergers
Veterans Day 2015
Happy Nurse Practitioner Week 2015
National Nurse Practitioner Week is held annually to celebrate these exceptional health care providers and to remind lawmakers of the importance of removing outdated barriers to practice so that NPs will be allowed to practice to the full extent of their experience and education. Continue reading Happy Nurse Practitioner Week 2015
Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care
“Raise your hand if you know of a physician you work with who should not be practicing because he or she is dangerous.”
Protection Money in Health Care
“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices.”
Lawsuit Exposes Insurance Industry’s Best Kept Secret
“Blue Cross’s accountants and actuaries determined what expenses Blue Cross wanted to recoup through the Disputed (Hidden) Fees, and then determined how much the hospital claims charged to the customers had to be falsely marked up in order to reach that amount.”
Continue reading Lawsuit Exposes Insurance Industry’s Best Kept Secret
Will Big Government Win Legal Battle Again in John Robert’s Court?
“Remember John, I’ve got pictures!”
BREAKING: SUPREME COURT TO CONSIDER OBAMACARE’S ATTACK ON RELIGIOUS LIBERTY
Continue reading Will Big Government Win Legal Battle Again in John Robert’s Court?
State of the TPA Industry & Market + Forecast for 2016
Personal candid comments from SPBA Active Past President Fred Hunt
I have been writing these candid report/forecasts for 35 years. I appreciate SPBA President Anne Lennan inviting me to continue the tradition each year. I am happy to say that the rate of accuracy (how things have turned out) of these reports & forecasts is about 90%. These were originally designed for reading just within SPBA, but our members believe in transparency, so the total candor is open for anyone to read. So, these are read not only by SPBA members to compare their situation to what I’m hearing from their peers….but these are also read by investors in SPBA firms, brokers, clients, etc.
Continue reading State of the TPA Industry & Market + Forecast for 2016
More Evidence of the Failure of PPO’s – “4th Largest City Has No PPO’s”
Seth Chandler, a law professor at University of Houston’s Health Law Policy Institute, put it even more bluntly: “It’s dramatic that the fourth-largest city in the country does not have a PPO.”
In 2015 there were 19 PPOs available in Harris County, 12 from Blue Cross Blue Shield and seven from Cigna Health Insurance, Chandler said. Now there is none.
“We found that the individual PPO plan was no longer sustainable at the cost it was being offered,” the company (BCBS) said. “Because we want to make sure that our plans are affordable, we decided to not offer individual PPO plans in 2016.”
Continue reading More Evidence of the Failure of PPO’s – “4th Largest City Has No PPO’s”
Collapsing ObamaCare Co-Ops Signal Big Trouble To Come
“Had the Democrats gotten their way, the public option would have covered up those issues and pushed the insurers out of business.”
Continue reading Collapsing ObamaCare Co-Ops Signal Big Trouble To Come
EHR State of Mind
I have a love-hate relationship with the Electronic Health Record (EHR). To be precise, it’s 90% hate, 6% love. The missing 4%? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages.
(See video at the end of this article)
Gastroenterologists Are Outraged Over Colonoscopy Reimbursement Cuts
GI societies plan to appeal the cuts to the CMS and are asking members to reach out to legislators.
Continue reading Gastroenterologists Are Outraged Over Colonoscopy Reimbursement Cuts
Texas Medicaid Numbers
States Take Aim At Health Insurance Providers Fee In New Litigation
Is another case related to the Affordable Care Act en route to the Supreme Court docket?
Continue reading States Take Aim At Health Insurance Providers Fee In New Litigation
A Cautionary Tail of Head-in-the-Sand TPA Practices
On Oct. 29, 2015, in southern district of Texas Federal Court, a TPA administered self-insured ERISA plan and plan sponsor were sued for alleged ERISA plan assets embezzlements, deceptively concealed with alleged “fake PPO (CO) discounts” and “fee forgiveness protocol scam”
Continue reading A Cautionary Tail of Head-in-the-Sand TPA Practices
Benefit Blog For Sale
A Physician’s Open Letter To Medicare Patients
“This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away.”
Continue reading A Physician’s Open Letter To Medicare Patients
ITL Announces Upcoming Conference
The insurance industry is in the midst of the most consequential season in its history, so ITL is proud to be partnering with Silicon Valley Innovation Center for Insurance Disrupted, Silicon Valley, 2015, a conference in Palo Alto, CA, on November 19 and 20, 2015. This timely gathering brings together many of the smartest people and best ideas from those who are shaping the future of insurance. You do not want to miss this summit. With limited space available, we recommend that you register today
Drugmaker to Offer $1 Version of $750-Per-Pill Medication
TRENTON, N.J. – Stepping into the furor over eye-popping price spikes for old generic medicines, a maker of compounded drugs will begin selling $1 doses of Daraprim, whose price recently was jacked up to $750 per pill by Turing Pharmaceuticals.
Continue reading Drugmaker to Offer $1 Version of $750-Per-Pill Medication
Pennsylvania Health System Offers Up-front Pricing, Prepayment
A Pennsylvania health system is making a significant change in how it charges patients for procedures. Instead of sending them or their insurers a complex bill with dozens of different charges after the fact, St. Luke’s University Health Network is posting all-inclusive prices for common procedures on its website, then having patients pay in advance.
Continue reading Pennsylvania Health System Offers Up-front Pricing, Prepayment
UCLA Health Offers Cash Pricing
UCLA Health offers cash pricing for selected services. Cash-pricing packages must be paid in advance of receiving services. Insurance will not be billed and claim forms will not be provided. If you would like information on cash packages, please call (310) 794-1125 or email us at priceinfo@mednet.ucla.edu
New Texas Medical Stop Loss Rules Considered – Growing Government Interference In Health Care
The Texas Department of Insurance (“TDI”) has drafted new and potentially transformative rules relating to medical stop-loss insurance policies issued in connection with self-funded employer health benefit plans.