Archive for November, 2015

The Value of Being Difficult

Sunday, November 29th, 2015
picky
“Under the PPACA, health care is no longer an employer’s moral responsibility but rather an individual responsibility” – Unknown 

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Games Brokers Play

Tuesday, November 24th, 2015

mulebriar

“Those who have data win. Those who have good data win a lot. Those who have real time data win all the time.”

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The Phenomenon of Balance Billing Under PPACA

Sunday, November 22nd, 2015

tomdick1

“Balance billing is representative of the last throes of a failed health care delivery system.”

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Saturday, November 21st, 2015

riskmanagerqqq

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.

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ObamaCare’s Fate Depends On Aetna / Anthem

Friday, November 20th, 2015

exit

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….”

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Tower Watson Sweetens Willis Merger Offer

Friday, November 20th, 2015

shutup

Willis is seeking Towers Watson to better compete with larger insurance brokers……..

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Colorado To Vote On Single Payer Health Care in 2016

Friday, November 20th, 2015

whatthehell

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………

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Obama-Scare: Biggest US Health Insurer Might Leave Exchanges

Friday, November 20th, 2015

obamasmile

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.

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Continental Benefits – Fast Growing National TPA

Wednesday, November 18th, 2015

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More Evidence of The Failure of PPO’s

Tuesday, November 17th, 2015

trust“This is part of an overall national trend to move away from PPO plans that come with high costs to consumers and offer little in the way of coordinated care.” – Statement from Blue Cross & Blue Shield

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Medicare Plus vs High Value PPO Network

Tuesday, November 17th, 2015

Increasing pressure from rising medical costs and the looming Cadillac Tax are pushing employers to consider innovative options to manage their Health Plans.

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Court Case Shows How Health Insurers Rip Off You And Your Employer

Tuesday, November 17th, 2015

ripoff“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.”

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The Hangover That Led To The Discovery of Ibuprofen

Sunday, November 15th, 2015

hangover

Dr Stewart Adams knew he had found a potential new painkiller when it cured his hangover ahead of an important speech.

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Donna ISD Mystery Indictment – Who Is Person “A” – Law Firm or Insurance Company?

Sunday, November 15th, 2015

mulebriar

“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. “

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I Am Retiring!

Friday, November 13th, 2015

retirement

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

Thursday, November 12th, 2015

angrydoctor1The American Medical Association asked U.S. antitrust regulators to block two proposed mergers that could reshape the health insurance industry.

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Veterans Day 2015

Monday, November 9th, 2015

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

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Happy Nurse Practitioner Week 2015

Monday, November 9th, 2015

American Association of Nurse PractitionersNational 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. (more…)

Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care

Sunday, November 8th, 2015

book

“Raise your hand if you know of a physician you work with who should not be practicing because he or she is dangerous.”

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Protection Money in Health Care

Saturday, November 7th, 2015

mulebriar

“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.”

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Lawsuit Exposes Insurance Industry’s Best Kept Secret

Saturday, November 7th, 2015

cookie

“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.”

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Will Big Government Win Legal Battle Again in John Robert’s Court?

Saturday, November 7th, 2015

rbert

“Remember John, I’ve got pictures!”

BREAKING: SUPREME COURT TO CONSIDER OBAMACARE’S ATTACK ON RELIGIOUS LIBERTY

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State of the TPA Industry & Market + Forecast for 2016

Friday, November 6th, 2015

fredhunt

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.

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More Evidence of the Failure of PPO’s – “4th Largest City Has No PPO’s”

Thursday, November 5th, 2015

houston

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.”

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Collapsing ObamaCare Co-Ops Signal Big Trouble To Come

Thursday, November 5th, 2015

obamacares

“Had the Democrats gotten their way, the public option would have covered up those issues and pushed the insurers out of business.”

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EHR State of Mind

Wednesday, November 4th, 2015

lovehate

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)

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Gastroenterologists Are Outraged Over Colonoscopy Reimbursement Cuts

Wednesday, November 4th, 2015

colon

GI societies plan to appeal the cuts to the CMS and are asking members to reach out to legislators.

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Texas Medicaid Numbers

Tuesday, November 3rd, 2015

eighteenMedicaid represents 20% of the entire state budge, about $24,500,000,000 (billion). Over 18% of the state’s population is enrolled in Medicaid, over 3,300,000 individuals.

States Take Aim At Health Insurance Providers Fee In New Litigation

Tuesday, November 3rd, 2015

courtIs another case related to the Affordable Care Act en route to the Supreme Court docket?

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A Cautionary Tail of Head-in-the-Sand TPA Practices

Monday, November 2nd, 2015

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”

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Benefit Blog For Sale

Monday, November 2nd, 2015

blogforsale

I have retired from employee benefits. This blog domain is one of kind. If you start typing in google’s search box the word; benefit, this benefitblog is first on the list. This can translate into a revenue generator for the firm purchasing benefitblog.

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A Physician’s Open Letter To Medicare Patients

Monday, November 2nd, 2015

rebeca

“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.”

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ITL Announces Upcoming Conference

Monday, November 2nd, 2015

insurancethought

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

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Drugmaker to Offer $1 Version of $750-Per-Pill Medication

Monday, November 2nd, 2015

dollarTRENTON, 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.

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Pennsylvania Health System Offers Up-front Pricing, Prepayment

Monday, November 2nd, 2015

stlukes

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.

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UCLA Health Offers Cash Pricing

Monday, November 2nd, 2015

UCLA Health

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

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New Texas Medical Stop Loss Rules Considered – Growing Government Interference In Health Care

Sunday, November 1st, 2015

foodstoeat

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.

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