Archive for February, 2016
Please enjoy these six recent articles from Insurance Thought Leadership………………….
The Interim Charge designation indicates the potential for the issue to become priority legislation during the next legislative session, which will reconvene in January 2017.
“Contraceptive Coverage at the Supreme Court Zubik v. Burwell: Does the Law Accommodate or Burden Nonprofits’ Religious Beliefs?”
“Given that the Court will be operating with only 8 Justices, what would be the impact of a tie (4-4) decision? “
Are Medicare supplemental insurance a good buy? This article by Dr. David Belk provides clues…………..
A Missouri jury has awarded $72 million to the family of an Alabama woman who died from ovarian cancer, which she said was caused by using Johnson & Johnson’s well-known baby powder and other products containing talcum.
“Yes, and it’s beautiful! The client does not have a clue about this. It will not show up on the 5500 Form either! It simply is not disclosed at all to the client.”
Two well-placed sources in Austin report that the Texas Department of Insurance (TDI) has decided to drop the pursuit of stop loss regulation.
Asserta Health assists employers with Cash Pay strategies
Hospitals and other providers increasingly are offering cash prices far below what they charge through insurance………….“I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?
Balance billing complaints are up 1,000 percent in Texas…………the patient was balance billed $1,170 for a total of five stitches ………… patient was served a $117,000 balance bill for an out-of-network physician’s assistant he never knew was present during surgery……………..physician charged Aetna $31,939 to treat abdominal pain in the patient. After Aetna paid the amount it deemed reasonable — $2,811, based on Medicare rates — the physician balance billed the patient for an additional $10,635.
As we all know, prescription drug costs are very hard to quantify over time. Costs are a moving target, changing constantly. Comparing PBM’s cost basis is next to impossible.
The hospital has confirmed the attack took place, but has not commented on the ransom.
A Texas statute requires healthcare insurers to make coverage determinations and pay claims made by preferred healthcare providers within a specified time or face penalties……Court finds statute is not applicable to BCBSTX’s activities as administrator of the self-funded plans………..
Data breaches from EHRs are only getting worse, making stricter enforcement of HIPAA requirements inevitable.
“At a time when virtually every municipality is finding ways to cut back health benefits in order to balance its budget, the city of Kirkland, WA, decided to create a moonshot goal–slay the healthcare cost beast while simultaneously improving the health of the city employees.”
In 2015, the Texas Legislature adopted House Bill 1295, which added section 2252.908 of the Government Code. The law states that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency.
“How is it that (health care) prices can continue to skyrocket? Unique to the healthcare market, increases in price fail to impact demand.”
“Preferred Provider Organizations (PPOs) perpetuate overpayments…………. average payments to hospitals of 250% of Medicare or more is horrendous, in many markets payment levels are twice that level and employers have no idea.”
Doctor sentenced to 30 years to life in prison for the murders of three of her patients who fatally overdosed…………..
“Market forces clearly have no effect whatsoever on the prices of brand name medications…………..”
Do Your Assignment of Benefits Clauses Need a Check-up? Recent Southern District of Florida Decision Highlights the Importance of Carefully-Drafted Provider Assignment Clauses
Cash pay reimbursement strategies should be an integral part of any self-funded employee health insurance plan………..
“THE PRICE IS TOO DAMN HIGH!”
Trump’s proposal is just the latest indicator of the increasing bipartisan support for government action on drug pricing……