Archive for January, 2016

Facts Suggest Hospitals & Insurers Agreed To Antitrust Scheme

Saturday, January 30th, 2016

shocked

Four ambulatory surgery centers alleged that two hospitals agreed to use their combined market power to compel physicians in the market not to refer patients to their competition and enlisted support from several carriers active in the health insurance market………

(more…)

Are You Paying For A “Lexus” Surgery & Getting a Pinto?

Friday, January 29th, 2016

lexusMoney that would have otherwise gone into investments or infrastructure development is now being diverted to employee healthcare benefits, and that has implications for the long term viability of every organization. (See Most Companies Shirk Fiduciary Duties When It Comes To Health Care)

MPIRICA offers free access to Provider Quality Scores for employers and plan participants……………..

(more…)

Drug Shortages Causing Rationing – Public is Clueless

Friday, January 29th, 2016

rationbood

Prescription drug shortages are the new normal in American medicine. But the rationing that results has been largely hidden from patients and the public.

(more…)

Left Coast Voters To Consider Rx Cost Reduction Strategy

Friday, January 29th, 2016

california1Among the catalysts for public outrage are the sky-high price of treatments for diseases such as hepatitis C and the unapologetic markups for specialty drugs by former pharmaceutical executive Martin Shkreli.

(more…)

Your Next Insurance Agent Will Be A Robot

Thursday, January 28th, 2016

robotA robot just gave your insurance agent a pink slip – doctors’ jobs are at risk, too…..

(more…)

Most Companies Shirk Fiduciary Duties When It Comes To Health Care

Wednesday, January 27th, 2016

bernieAn excerpt from the preceding post on this blog (Florida Business Coalition Set to Revolutionize Health Benefits Purchasing) says it all. Some plan sponsors are better at managing fiduciary duties than others. They take these duties seriously while others simply ignore common sense, fail to understand health care financing and rely on vested interests memorialized through contracts of adhesion.

Perhaps the finger of blame for the high cost of health care should be directed at the payer, not the medical provider community  – RiskManagers.us

(more…)

Florida Business Coalition Set to Revolutionize Health Benefits Purchasing

Wednesday, January 27th, 2016

whydidnt“How many businesses do you know that want to cut their revenue in half? That’s why the healthcare system won’t change the healthcare system.” Rick Scott – Governor of Florida

Orlando-based Rosen Hotels have shown how straightforward it is to slay the healthcare cost beast. They spend 50% less on health benefits than a typical employer while providing outstanding benefits

(more…)

Some Work-Based Health Plans Exclude Outpatient Surgeries

Wednesday, January 27th, 2016

fineLibbi Stovall couldn’t believe it last month when she looked at the fine print in her company’s 2016 health plan, which supposedly meets the strictest standard for employer obligations under federal rules.

(more…)

Reduce Health Care Costs 30% Through Level Funding

Wednesday, January 27th, 2016

levelfunded

Immediately reduce health benefits costs by $50K, possibly $250K or more……….

(more…)

Rampant Out-Of Network Provider Litigation Continues

Tuesday, January 26th, 2016

perrymason

Litigation involving out-of-network providers, meaning providers who do not have a negotiated rate agreement with the respective payer, continues to be rampant. Certain issues arise frequently in these lawsuits over whether the payers had properly paid claims.

This article discusses several published decisions from 2015 that illustrate how courts across the country are handling some of these common issues.

(more…)

ClearHealth Delivers Medicare-Based Pricing Programs

Monday, January 25th, 2016

Clear Health Strategies

ClearHealth delivers comprehensive Medicare-based pricing programs that are fully configurable to allow your organization to achieve maximum savings while using a cost containment strategy tailored to meet your strategic goals.

(more…)

BUCA Document Exposes Out-of-Network Reimbursement Strategies

Monday, January 25th, 2016

mulebriar

Part of a continuing series………..(See previous two posts)

“Reasonable charges for inpatient and outpatient facilities generally equal twice a facility’s cost as reported by the facility to CMS….” (more…)

Working the “Spread” – Another PPO Revenue Stream

Monday, January 25th, 2016

mulebriar

By Molly Mulebriar

In our continuing efforts to expose insurance industry secrets that drive up health care costs, we find more evidence of third party skimming through managed care contracts.

(more…)

PPO Requires Payment of Denied Claims?

Friday, January 22nd, 2016

confusedPPO agreement requires self-funded plan to pay certain claims that otherwise would be denied……………………..

(more…)

Cameron County Seeks Health Insurance Consultant

Thursday, January 21st, 2016

hiringCameron County desires to enter into a contract with a qualified consultant……….

(more…)

Dear Bernie…………..

Tuesday, January 19th, 2016

canadafarm

The current single payer system in Canada presented a solution in a time when farmers, who had little or no money for healthcare, represented the major demographic in the country and a cooperative type model was therefore attractive.

But times have changed……….…………………

(more…)

The Murkey World of Actuaries

Sunday, January 17th, 2016

odds1Harry Nostradamus

Actuaries ponder philosophical mutterings under the basis of implied thought influenced through critical thinking……………..

(more…)

Plan Sponsors: Prudent Business Practice Requires Actuarial Support

Sunday, January 17th, 2016

riskassesmentDoes your TPA, broker or consultant provide actuarial support as part of their service offering? An actuarial analysis should be performed annually. A small cost factor in overall plan spend, actuaries provide essential services important to fulfilling fiduciary duties.

(more…)

Obamacare, Sign Me Up!

Saturday, January 16th, 2016

screwed“ACA grace period could affect dental practices – Has your practice received calls asking for the return of third-party payments?”

(more…)

Take A Blood Test Or Lose Your Health Insurance

Friday, January 15th, 2016

needle1

Dale chose not to take his work-sponsored health assessment and biometric screening. His company responded by pulling his insurance coverage.

(more…)

Kashable – Group Credit Benefit Program

Thursday, January 14th, 2016

kasableKashable’s alternative consumer lending program provides affordable credit to US employees through employers, PEO, payroll companies, private healthcare organizations and benefit exchanges.

(more…)

ObamaCare Fuels Growth of Concierge Medicine

Thursday, January 14th, 2016

concierge

A growing number of primary care doctors, spurred by the federal health law and frustrations with insurance requirements, are bringing a service that generally has been considered “health care for billionaires” to middle-income, Medicaid and Medicare populations.

(more…)

N.Y. Policy on Out-of-Network Medical Bills, a Model for Other States?

Wednesday, January 13th, 2016

newyork1

By Drew Altman

Medical bills for out-of-network providers can surprise consumers with thousands of dollars in costs they didn’t plan for and sometimes cannot afford.

(more…)

Aetna CEO Sees Humana Deal on Track to Close This Year

Wednesday, January 13th, 2016

lemon“Insurers say the combinations will give them greater leverage to control rising healthcare costs.” TRANSLATION: Insurers can squeeze more out of the lemon

(more…)

Drugmakers Raise Prices Despite Criticisms

Monday, January 11th, 2016

bang

Stress Reduction Kit For Frustrated Plan Sponsors

Drugmakers didn’t let up on price increases with the start of a new year, demonstrating the industry’s pricing power in the face of mounting criticisms of prescription costs in the U.S.

(more…)

McAllen ISD Reaches Out To 1,462 Insurance Consultants

Sunday, January 10th, 2016

mulebriar

“The District invited one thousand four hundred sixty-two (1462) vendors to submit a proposal and six (6) vendors responded.”

Amazing stuff – who would have guessed there were that many licensed insurance consultants in the state” – Molly Mulebriar

(more…)

Beating Medical Trend – Managed Care vs Reference Based Pricing

Sunday, January 10th, 2016

arrow

“Reference Based Pricing represents the last frontier in innovation to control health care costs in a tightly regulated and controlled market”– Bill Rusteberg

(more…)

Hand In The Cookie Jar?

Sunday, January 10th, 2016

cookie

This is another of many recent examples of a third party intermediary’s alleged embezzlement of plan assets deceptively concealed through fake PPO discounts.

A BCBS survey was conducted and found that 83 percent of its self-insured clients were completely unaware of the hidden fees…………

(more…)

Renting Medicare’s Provider Network

Friday, January 8th, 2016

 democratrepublican

An idea with bi-partisan support?

If the federal government would rent their Medicare network and charge what the private market charges for PPO access, the government would rake in millions, if not billions of dollars in access fees. This would generate enough money to buy health insurance for those that don’t need it.

(more…)

AWP As A Rx Pricing Benchmark

Thursday, January 7th, 2016

shellDue to pricing fraud, many payers, including government payers, are no longer using AWP for pricing, and are switching to other more transparent pricing benchmarks…….AWP is subject to fradulent manipulation by manufacturers or even wholesalers. As such, the AWP, while used throughout the industry, is a controversial pricing benchmark….

(more…)

Custom Design Benefits Announces Changes – True Cost Product Gains Momentum

Thursday, January 7th, 2016

mueller Julie Mueller

Munninghoff said his accounting firm’s experience with TrueCost influenced his decision to invest in Custom Design Benefits.

An exclusive new product called TrueCost, a reference-based pricing solution for firms with as few as 50 employees was developed by Custom Design Benefits in 2012, TrueCost eliminates deductibles and co-insurance and reimburses all medical providers based on Medicare plus a bonus.

(more…)

Benestream – The Medicaid Migration Company

Thursday, January 7th, 2016

benestream

“Reduce your costs by moving employees onto free health insurance with Medicaid Migration”……….

Are private, free enterprise employers who traditionally oppose government interference in business actively encouraging growth of a massive entitlement program many are philosophically opposed?

(more…)

Employers Save By Moving Workers To Medicaid

Thursday, January 7th, 2016

shocked

Companies shift insurance costs to the government….……….

Employers have not historically played a significant role in helping workers enroll in Medicaid……………..until now

(more…)

Swiss Re To Purchase IHC

Wednesday, January 6th, 2016

swissSwiss Re Corporate Solutions has signed an agreement with Independence Holding Company (NYSE: IHC) to acquire IHC Risk Solutions, LLC and its direct employer stop loss (ESL) business, for an aggregate of USD 152,500,000 in cash.

(more…)

Medicare: Big Changes Coming For Hip, Knee Surgery Payments

Wednesday, January 6th, 2016
'I guess I don't need to ask how your new hip is working out.'

‘I guess I don’t need to ask how your new hip is working out.’

“This model will incentivize providing patients with the right care the first time and finding better ways to help them recover successfully. It will reward providers and doctors for helping patients get and stay healthy.”

(more…)

Health Insurers Have No Reason To Reduce Price of Health Care

Monday, January 4th, 2016

confusedHealth insurers who administer self-funded plans for employers have no incentive to keep costs down, rather the incentive is to drive costs up to earn higher administration fees as well as fees earned off PPO spread pricing – Homer G. Farnsworth, M.D.

(more…)

The Case of The Missing + 3%

Sunday, January 3rd, 2016

What Do Three Men, A Hotel & A Third Party Intermediary Have In Common With Health Care Financing?

peopleIn this illustration, you will learn how RiskManagers.us skillfully portrays an illusion to reduce inflated billed charges by almost 17% , saving each of the three men 10% while enriching a third party intermediary by approximately 7% of billed charges with an additional + 3% vanishing inexplicably into thin air.

Understanding this riddle will clearly show how opaque and illusionary health care financing can be…………………..

(more…)

Free Audit Lift Benefits Brokerage

Friday, January 1st, 2016

competitionA new company in town is shaking up local insurance brokers by offering to take a free look at what employers pay for benefits, to see if it can get them a better deal……………..

Competition breeds hostility in some people,” he said. “Bottom line: There aren’t any brokers who offer what we offer………….

 

(more…)