Who’s to blame for high drug prices? Most would probably point the finger at Big Pharma, but a group representing pharmacists say that a big part of the problem is middlemen empowered by insurance companies.
Archive for June, 2016
Texas Free Market Surgery is a partnership between the best surgeons and innovative business partners with a vision to supplant a broken healthcare system with a new innovative model that delivers the best care at affordable prices for patients and families.
Revamping traditional Medicare’s benefit design and restricting “first-dollar” supplemental coverage could reduce federal spending…………..Medicare Supplemental Coverage in danger of extinction?
Is your third-party administrator holding out on you? Maybe you should check.
We’re pleased to announce our participation in Healthcare Payments Innovations scheduled for July 26-27, 2016, at the Chicago Hilton/Magnificent Mile Suites. We will be presenting a special feature presentation on Population Health and How Payments Must Evolve at 10 am on July 26 2016.
Employers react to ObamaCare with cost shifting…………….Hospitals must upcharge to recoup……..the health care cost increase cycle never ends, it just gets worse – Molly Mulebriar
These results are excerpted from the Blue Cross Blue Shield edition of the 2016 Sherlock Expense Evaluation Report.
The nation’s Blue Cross and Blue Shield plans fared worse than publicly traded health insurance companies, with many plans losing hundreds of millions of dollars last year on individual policies sold under the Affordable Care Act.
Some Texas political subdivisions have reduced costs and improved benefits. Others have experienced the opposite.
Texas is seeking competitive proposals for TPA services for the state’s employee health & welfare plan.
The Lower Rio Grande Valley of Texas has produced many achievers over the years. Israel Rocha is one of them.
“Israel Rocha has been a transformative leader not only at DHR, but across the region,” Board Chairman Dr. Carlos Cardenas said in a prepared statement. “He has helped increase our community’s ability to care for patients and has successfully led the hospital during times of rapid change in the healthcare industry.”
Selection of a third party administrator (TPA) is crucial to the success of a self-funded plan. Criteria usually revolve around several factors including compatibility. Corporate philosophies of the employer and TPA should harmonize.
The operation is designed to combat glaucoma, which can lead to permanent loss of sight.
Experts said harnessing the body’s own defences was now giving “new hope” to cancer patients. The field – known as immunotherapy – is one of the most exciting in cancer treatment.
“It’s a myth that bundling all services through one integrated vendor saves money. What employers may save on administration, they lose in competitive rates, flexibility and transparency.”
Insurance brokers fight a daily battle to gain new clients. It’s a tough business. You only get paid when you win, which is not that often. With an average closing ratio of less than 10% for group health insurance sales, one must wonder what is the main competition facing independent business men and women in the rough and tumble world of insurance sales?
“Hospital chains that buy up other facilities, clinics and physician offices often tout savings and improved services from coordinating patient care and eliminating inefficiencies. The researchers found no evidence that any potential savings were being passed along to the employers, insurers and patients who pay for the care.”
Employers are facing significant risks from data breach but few are prepared for the consequences……
A Texas based association sponsors a group medical plan for member firms throughout the state administered by a nationally recognized insurance carrier. As a service to their members, the association performs billing services on behalf of the carrier. Following the money is not always easy.
Funds are withdrawn under the guise of a “savings” compensation structure as a means to cloak blatant misappropriation of funds…….fake discounts and fabricated contractual obligation………….
San Patricio County recently paid $17,000 for complete knee replacement through their Cash Pay Plan Option managed by Asserta Health. This global fee did not only include hospital charges, it includes surgeon, assistant surgeon, anesthiologist, and other associated services.
Although the following article does not mention Cash Pay Plan Options, the reader should know Cash Pay Plans are the next evolutionary step for plan sponsors seeking fair and competitive health care costs. Asserta Health – www.Assertahealth.com
The requirements of the Texas law are more stringent than those of its federal counterpart, the Health Insurance Portability and Accountability Act (“HIPAA”)………..HB 300 also requires any business in Texas that handles PHI to provide notification to individuals of a breach of their personal information.
“Given the potential consequences, it is critical that covered entities and business associates respond appropriately to potential HIPAA breaches to avoid or minimize their liability.”
HIPAA violations are expensive. “The penalties for noncompliance are based on the level of negligence and can range from $100 to $50,000 per violation (or per record), with a maximum penalty of $1.5 million per year for violations of an identical provision. Violations can also carry criminal charges that can result in jail time.”
By Bill Rusteberg
In a 2016 report, the TRS ActiveCare financials for 2015 should cause concern among Texas lawmakers. Because the state and district’s minimum plan contributions have not changed since 2002, active employee contributions have been raised each year to cover the projected expenses and claim costs.
Obamacare was intentionally designed to fail because it was the only way they could force the country onto a federal system of socialized medicine. Now we’re all watching it happen.
“I argue that the government needs to step in, not to take over responsibility for providing healthcare, but just the opposite, to eliminate the chargemaster pricing system…………”
Kickbacks of $15,000 for each lumbar fusion surgery and $10,000 for each cervical fusion surgery..more than $580 million in fraudulent bills for spinal surgeries during the last eight years at one hospital alone……….
Unelected government officials want to limit use of short-term health insurance in the United States to periods of three months or less.
Government hacks are also thinking about the possibility of banning the sale of critical illness policies and other policies that cover two or more specific diseases.
Flanders, a longtime media executive, has been an eHealth board member since 2008, and CEO of Beverly Hills-based media company Playboy Enterprises Inc. since 2009. In the past year, he has attracted attention by giving interviews to explain why Playboy magazine stopped running nude centerfolds.
“It’s possible to deliver ”twice the healthcare, at half the price and 10 times the delight.” It might sound too good to be true but employers large and small are doing it and spending 20-55% less per capita on health benefits with packages that are better than what 99% of the workforce gets. It simply takes will.”
Entitlement Mentality Grows
“The report reveals many other aspects of health and health care, but the main message rings true: citizens want health care for themselves and other citizens.”
Martita – Dewitt County Resident Reacts to proposed rate increase
Bad news for folks in Dewitt County, Texas. The only individual health insurance policy one can purchase there is one from Blue Cross. And, the only policy Blue Cross sells to the poor souls of DeWitt County is an HMO policy. Have cancer, forget about going to MD Anderson just down the road in Houston.
Our friend Martita, age 60, currently has a $6,000 deductible Blue Cross HMO individual policy with an annual premium of about $7,000. With a 60% increase she will pay about $11,200. If she gets sick, her out of pocket costs could be $17,200…………………
How about putting $17,200 in a tax free savings account and purchasing a $20,000 deductible health plan? No can do, that’s now illegal………………..
Jobs in health care, education, and social services have exploded. When Obama took office, just over 19 million Americans worked in this sector. Today, almost 23 million do.