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………
Archive for January, 2016
Money 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……………..
Prescription drug shortages are the new normal in American medicine. But the rationing that results has been largely hidden from patients and the public.
An 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
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
Libbi 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.
Immediately reduce health benefits costs by $50K, possibly $250K or more……….
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.
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.
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…)
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.
PPO agreement requires self-funded plan to pay certain claims that otherwise would be denied……………………..
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……….…………………
Actuaries ponder philosophical mutterings under the basis of implied thought influenced through critical thinking……………..
Does 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.
Dale chose not to take his work-sponsored health assessment and biometric screening. His company responded by pulling his insurance coverage.
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.
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.
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.
“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
“Reference Based Pricing represents the last frontier in innovation to control health care costs in a tightly regulated and controlled market”– Bill Rusteberg
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…………
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.
Due 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….
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.
“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?
Companies shift insurance costs to the government….……….
Employers have not historically played a significant role in helping workers enroll in Medicaid……………..until now
Swiss 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.
“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.”
Health 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.
What Do Three Men, A Hotel & A Third Party Intermediary Have In Common With Health Care Financing?
In 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…………………..