People travel to visit family and attend business meetings, so why not travel for medical care?
Continue reading Affordable Health Care Is Just A Road Trip Away
People travel to visit family and attend business meetings, so why not travel for medical care?
Continue reading Affordable Health Care Is Just A Road Trip Away
“Reference-based pricing is unquestionably a hot topic in the self-funded industry today. So hot, in fact, that the federal government has taken an active interest in it for the third time now……”
Continue reading Regulators Scrutinize Reference Based Pricing Plans – Phia Group To Host Webinar
Walmart, Kmart, Safeway, and Kroger all charge $45 for the sildenafil, using the discount card, while Walgreens charges $450 and RiteAid $1,000…………
Continue reading CVS Buys Target Pharmacies, Jacks Up Prices
By: Peter Vieth April 22, 2016
For what may be the first time in Virginia, a judge has ordered a hospital to slash its “balance billing” charges by 75 percent to reflect the hospital’s usual write-off for uninsured patients.
Continue reading Challenge To ‘Balance Billing’ Hits Hospital
“We have been sold on the idea that this particular incarnation of the HMO/Managed Care will save the government, save physicians and save patients all at the same time. …….The biggest sin the ACO’s commit is to distract from any real conversation about cost………… “
In the first two days, we had visits from the Florida Legislature, the Florida Department of Insurance, the Florida Department of Health, Humana, UnitedHealthCare, Cigna, Aetna, the Blues, and a range of Florida hospitals.
A researcher paid a middleman procurement company $3,340 for a fetal brain, $595 for a “baby skull matched to upper and lower limbs,” and $890 for “upper and lower limbs with hands and feet.”
Continue reading In the Market for Fetal Body Parts, a Baby’s Brain Sells for $3,340
The $64,000 Question
Can a plan exclude specialty drugs? The answer is yes. Many PBM’s limit their specialty drug formularies. But, can a plan eliminate all specialty drugs and remain ACA compliant?
How did we get here and why is this so hard to fix?
Continue reading David Belk Publishes New Conclusion Regarding Health Care Costs
John Smith Stunned By Cheap Medical Premiums
Nothing like screwing insurance companies….…………
Continue reading Short Term Medical Insurance – How To Beat The System
Petr Kellner got his start in the early 90’s selling office supplies……………
This year’s billionaires with connections to the insurance industry include the son of a Chicago meat-packer, a former appliance door-to-door salesman, a World War II flight navigator and a passionate environmentalist.
Arlington Healthcare Group is an established healthcare industry consulting and professional services firm. We help healthcare providers, payers, and industry technology and service enterprises grow and optimize performance and value.
The insurance and financial services company opened its doors 40 years ago on April 1, 1976, by principals Charlie Amato and Gary Dudley with only $1,500 in capital……“When we started this company, we had no idea of the incredible journey it would take us,” said Charlie Amato, chairman and co-founder……..
Want to save as much as 75% or more on your health insurance premium costs? Try a short term medical policy.
Continue reading ACA’s Unintended Consequences: People Buy Short-Term Policies
Enchiladas, tostadas, tacos – getting hungry yet? Grab a cerveza and read on.
Continue reading Government Approves Corn Tortillas
Sam Crafting, Health Care Editor – New York Times
“A business that operates at a loss should raise it’s prices” – Sam Crafting
“Don’t bother doing something unless your radically different from the competition” – Richard Branson
By Bill Rusteberg
Reference Based Pricing, or Cost Plus Insurance has evolved over the past seven years from simply re-pricing claims based on established benchmarks such as Medicare pricing schedules, to a number of evolving hybrids. A Cash Pay Health Plan Option is one, quickly gaining market attention among health care revolutionaries.
Continue reading Cost Plus Insurance Evolves – What A Difference 5 Years Makes
“It’s clear hospitals view owning a health plan as a way to build their population health programs by combining medical claims and clinical data.”
Continue reading Enrollment In Provider-Owned Health Plans Is Rising
Actuary Panics – Pleads for Mercy
“There are enough people enrolled at this point that the market is sustainable. The premiums were just too low.”
Continue reading Insurers Warn Losses From ObamaCare Are Unsustainable
The movement to protect consumers from surprise medical bills won a major victory Thursday when Florida Republican Gov. Rick Scott signed a bipartisan bill that will exempt patients from having to pay balance bills from out-of-network providers in certain situations.
Continue reading Rick Scott Signs Law Shielding Patients From Balance Billing
By Bill Rusteberg
Reference Based Pricing for health care has become the fastest growing trend in the American health care delivery system. Insurance agents, brokers and consultants upon which health care payers depend for market distribution, are joining the health care Reference Based Pricing revolution in droves. Selling health insurance is becoming fun again. Competing for business has reached new levels of intensity.
Continue reading The Phenomenon of Reference Based Pricing – Are Cash Pay Plans Next?
Gamblers consistently overestimate the control they have over outcomes, both in gambling and in everyday life. Their belief leads them to engage in seemingly bizarre or ritualistic behaviors such as throwing dice in a certain way or wearing specific colors…….. the illusion of control is widespread, and its effects may be enhanced when people are placed in positions of authority or subjected to time pressure or competition………….
Continue reading The Science of Choosing Wisely — Overcoming the Therapeutic Illusion
“Only 5% of patients with obesity who lose weight keep it off. Coverage for obesity drugs is improving, but remains uncommon. Only a tiny fraction of the candidates for bariatric surgery have the operation, in part because 70% of physicians won’t give referrals.”
Continue reading Overcoming Stigma Essential to Improving Payer Coverage for Obesity
Hello everyone. Once again, it’s time for another case study on how our health care industry is robbing us blind.
Region One Educational Services Center, hereinafter referred to as “ESC”, desires to solicit proposals for various firms to perform as a Third Party Administrator for the ESC’s Cafeteria Benefits Plan (IRC Section 125), Flexible Spending Accounts and Dependent Care Spending Accounts.
Continue reading Region One Educational Services Center Seeks TPA
“Over the past two years, hospital chains and insurance companies have snapped up urgent-care centers in a spate of mergers and acquisitions.”
Continue reading Traditional Providers Get Into the Urgent-Care Game
“Chronic diseases that require lifetime treatment and symptom management account for approximately 86 percent of all healthcare expenses…”
Continue reading Healthcare Initiative is Changing the Way Hospitals Do Business
“It’s a common practice but it’s wrong.” – Arnulfo Olivarez at his 1/24/2011 sentencing for bribery before Judge Hinojosa.
“As someone that has made a career trying to help healthcare providers and health plans get on the same page as it relates to cost-containment initiatives, I have compiled my personal top ten lessons about RBP from 2015.” – Jason C. Davis
Continue reading Top Ten Lessons Of A Reference Based Pricer
Former Health Insurance Broker
“Some insurers, including Anthem and Humana, say they dropped commissions to keep rates down.”
The proposal attempts to address what DOL and the White House claim are systemic conflicts of interest in broker advisor models………….The proposed rule clearly favors fee-based compensation models for advisors…………….
Although the proposal targets pension and investment advisers per se, the same standards may be applied to fee based insurance consultants – Molly Mulebriar
Continue reading Fixing Systemic Conflicts of Interest In Broker Adviser Models
The Untouchables
“There have been numerous stories over the years, published widely, regarding “double dipping” by fee based insurance consultants. The scheme is lucrative, with little chance of punishment…..”
Continue reading Are Insurance Consultants Unbiased? Or Does Money Affect Behavior?