Archive for August, 2016

Single Payer System Is Inevitable

Monday, August 29th, 2016

angryteacher

The following article is based on the premise that health insurance is health insurance. In truth, “health insurance” is not insurance at all but has simply become a government mandated welfare assistance program administered by insurance companies and TPA’s.

(more…)

Consultants Compete To Help Insurers To Manage Costs

Monday, August 29th, 2016

With ObamaCare in full swing, with little likely hood of meaningful repeal, insurers are targeting population management and statistical metrics to bolster a competitive edge and revenue…..

(more…)

Anchoring Health Care Pricing (See Previous Post)

Sunday, August 28th, 2016

confusedHospitals have charge master pricing. Pharmaceutical manufacturers have AWP pricing. Consumers pay neither. These are simply made up numbers from which sellers “discount” their wares/services.

(more…)

Anchoring – What Car Dealers & Hospitals Have In Common

Sunday, August 28th, 2016

aaaaaaaaaam

That first number thrown out there serves as an anchor — a first reference point. Every other price becomes an adjustment of that price. Take a hospital’s charge master rates for example………..

(more…)

When Should Patients Pay Cash for Prescriptions?

Sunday, August 28th, 2016

cash-pay-model

Some consumers who pay far more than the cash price of a medication when using health insurance.

(more…)

8 Memorable Quotes About Hospital Prices

Friday, August 26th, 2016

fridge

“There’s more price transparency and quality transparency regarding a refrigerator than there is about your heart surgery.”

(more…)

Health Insurance Agents Turn To Begging

Wednesday, August 24th, 2016

beggar

Please Mr. Plan Sponsor, pay me direct. I really am worth it! I used to get $35,000 per year on your 75 employee life group plus an undisclosed bonus. I’m sorry I only showed up on renewal, and I promise I will change that. Please, Please, Pretty Please…………………

(more…)

Price Gouging Continues – Deep Pockets Targeted

Wednesday, August 24th, 2016

pockets

As long as health plans, with deep pockets, continue to roll over and play dead, health care costs will escalate to a point the entire health care finance system will implode.

(more…)

Health Care Pricing Transparency Drives Competitive Free Market

Wednesday, August 24th, 2016

albetross

Consumers Flee High Cost Hospital 

Texas General Hospital in Grand Prairie may be struggling to attract patients for elective services after a report named it the most costly hospital in the state, reports Dallas Observer.

(more…)

Largest Physician Owned Hospital in USA Expands Foothold

Monday, August 22nd, 2016

 

dhr12

Edinburg, TX–– Leaders at Doctors Hospital at Renaissance Health System (DHR) and Mission Regional Medical Center (MRMC) have signed a non-binding letter of intent (LOI) to explore collaborative opportunities between the organizations.

(more…)

Who Is Getting Rich from the Price of Prescription Drugs?

Sunday, August 21st, 2016

moneyrich

Today, most drug companies offer large rebates to pharmacy benefit managers on behalf of different health plans and employers to reduce patients’ out-of-pocket costs. The problem is a significant portion of the savings is not being passed onto the public.

(more…)

PBM Exposes Industry Secrets on Specialty Drugs

Sunday, August 21st, 2016

shellgame1The audience was aghast to learn that a specialty drug for Hep.C. earned PBM’s a 45% commission for one course of treatment………..

(more…)

Pascal Metrics Provides Patient Safety Analytics

Sunday, August 21st, 2016

pascalmetrics

Pascal Metrics is the field leader in measuring and improving patient safety through advanced Patient Safety Analytics (PSA).

(more…)

Comrade Bernie Touts Medicare for All

Thursday, August 18th, 2016

communitsSen. Bernie Sanders says the ability of Aetna to disrupt the public health insurance exchange system in 2017 by withdrawing from 11 states’ programs shows why letting private companies sell health insurance is a bad idea.

(more…)

BMA TPA Announces New Website

Thursday, August 18th, 2016

bma

San Antonio, TX – Locally owned BMA (Third Party Administrator of Health Insurance plans) announced today that it has launched a new Web site along with enhancements to its End User Portal. Company officials are excited to make this upgrade to their Web site and enhance the user experience in their end-user Portal.

(more…)

Employers Look To Direct Health Care Contracting

Wednesday, August 17th, 2016

middleman1

Cutting out the middle man………………………..

Industry denials notwithstanding, reducing healthcare costs is fundamentally against nearly every healthcare organization’s perceived economic interests.

(more…)

Specialty Drugs – What Can A Plan Sponsor Do?

Tuesday, August 16th, 2016

bulletSpecialty drugs are bankrupting self-funded health plans. 

(more…)

Drug Crazed Elderly – America’s Other Drug Problem

Tuesday, August 16th, 2016

elderlydrug

An increasing number of elderly patients nationwide are on multiple medications to treat chronic diseases, raising their chances of dangerous drug interactions and serious side effects.

(more…)

Texas School Districts – Insurance Fraud & Political Empowerment

Monday, August 15th, 2016

favor

“No problem Joe, I’ll make a call for you”

(more…)

Why You Can’t Find The Doctor You Need

Monday, August 15th, 2016

sorry

Some exchange plans are paying doctors less than Medicaid pays. Blue Cross in Dallas, for example, pays some doctors 10% less than Medicaid’s fee. If insurance buyers were forewarned, that would be one thing. But no exchange plan is advertising that access will be worse than it is for Medicaid patients.

(more…)

Health Care Statistics Between USA, England & Canada

Sunday, August 14th, 2016

kinggeorge

King George III ruled England, Canada and what is now the USA. All three share the same language and are similar in many ways. But health care statistics show the USA a leader in health care delivery.

(more…)

Keeping Up with New Payment Models: “Cost Plus” or “Medicare Plus”

Sunday, August 14th, 2016

newrealityProviders across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans.

(more…)

CFOs & HR Execs Facing Millions In Personal Liability Over Health Plans

Sunday, August 14th, 2016

fiduciaryThe first shots across the bow have been fired highlighting how benefits leaders need to pay as close attention to health benefits as they have been paying to retirement plans.

“The Number One Hidden Cost for Plan Sponsors is Embezzlement of Plan Assets” – Bill Rusteberg

(more…)

Video Helps TPAs To Market Reference Based Pricing Plans

Sunday, August 14th, 2016

rbpricingThis video is the second in a series and features a bold, fresh white board format to explain how a growing number of self-funded health plans are using Reference Based (or Cost Plus) Pricing to cooperate with area hospitals to agree on a pre-determined margin, thereby eliminating PPO networks.

(more…)

Hospitals Disposing of Organs, Refusing Transplants

Friday, August 12th, 2016

transplantorganFear poor outcomes yield worse federal performance ratings…….punishable by less Medicare funding to hospitals with lower ratings….. 

(more…)

Tenet Healthcare Terminates Humana Contract

Thursday, August 11th, 2016
'You're fired, eliminated, laid off, let go, downsized, terminated ...'

‘You’re fired, eliminated, laid off, let go, downsized, terminated …’

Tenet Healthcare has notified Humana that as of September 30, 2016, Tenet Healthcare facilities and physicians will no longer be participating in any Humana provider networks.

(more…)

How Common Procedures Became 20 Percent Cheaper for Many Californians

Thursday, August 11th, 2016

amazing

At a time when health care spending seems only to go up, an initiative in California has slashed the prices of many common procedures.

(more…)

Next President Faces Possible ObamaCare Meltdown

Thursday, August 11th, 2016

thatcher

The next president could be dealing with an ObamaCare insurer meltdown in his or her very first month.

(more…)

BCBS Offers RBP Selling Tips

Thursday, August 11th, 2016

Aug. 10, 2016

Tips for Explaining Reference-based Pricing to ASO Employer Groups

(more…)

Call To Action – Help Expose The Truth – Whistle Blowers Welcome

Tuesday, August 9th, 2016

mulebriar

Insurance insiders know the truth about undisclosed compensation paid to insurance agents, brokers and consultants by the BUCA’s. It is the industry’s best kept secret ( Health Insurance Consultant’s Best Kept Secret)

(more…)

Patient Held Hostage By Hospital Over $53,000 Bill

Monday, August 8th, 2016

hostage

Ms. Stinson had a 99 percent blockage of an artery, and her family was forced by the hospital to pay $25,000 before she could receive treatment, Ms. Stinson’s son-in-law told the Indy Star. A second blockage was discovered, and the hospital demanded $30,000 upfront before the second operation.

(more…)

Big California Firms Take On Health Care Giant Over Cost of Care

Monday, August 8th, 2016

boxing

Big California Firms Take On Health Care Giant Over Cost of Care

(more…)

Scheme Switches Medicare/Medicaid Patients to Private Insurance

Sunday, August 7th, 2016

whydidntUnitedHealthcare says in its suit that American Renal Associates billed out-of-network prices of about $4,000 per dialysis treatment, much higher than the $200 paid by the Florida Medicaid program.

(more…)

McAllen ISD To Award TPA Contract – Proposed ASO Agreement Made Public

Saturday, August 6th, 2016

missionimpo

Mr. Phelps of Mission Impossible

Your mission Jim, should you decide to accept it, is to review all documents to ensure best value for the McAllen Independent School District. As always, should you or any of your staff be caught or killed, the Secretary will disavow any knowledge of your actions. This pdf will self-destruct in five seconds. Good luck Jim.

(more…)

Proposed Form 5500 Changes To Increase Plan Sponsors Obligations

Saturday, August 6th, 2016

shocked

It is clear that future Form 5500 reporting obligations will require more data, more resources and be subject to increased scrutiny by Federal agencies. Employer sponsors of group health plans should begin to evaluate plan documentation and the potential new disclosures required by Schedule J to ensure that each plan sponsor will be in a position to access such information and adequately communicate the new reporting requirements.

(more…)

Most Expensive Fairy Tale of The Modern Era

Saturday, August 6th, 2016

fairytale

“The notion that insurance companies previously charged high premiums, or withheld coverage, from “high-risk” customers because they were evil and mean and greedy, but now Daddy Obama would make them see the error of their ways, was the dumbest and most expensive political fairy tale of the modern era.”

“The illusion of lower premiums today would be financed by higher tax bills tomorrow, and of course they’d never tell you they were raising your taxes to keep the ObamaCare scam floating. They’d tell you it was for bridges, or schools, or Social Security solvency, or something.”

(more…)

Deerwalk, A Powerful Tool For Plan Analytics

Friday, August 5th, 2016

Yes_Baby

Does your TPA use Deerwalk? Deerwalk is a state of the art system that will allow, among other things, a plan sponsor to compare PPO pricing against Medicare benchmarking on a real time basis. Plan sponsors, for the first time, can determine the real value of PPO “discounts”. Many will be shocked by the results.

(more…)

The ACA Medical Loss Ratios – “COST-PLUS” Health Insurance in Disguise

Thursday, August 4th, 2016

evans

By Jeff Evans

I recently read an opinion piece that effectively summarized much of what many of us, in the health insurance and employee benefits business, have already figured out.”

(more…)

Managed Care – Cat Is Out of The Bag

Thursday, August 4th, 2016

catoutofbagBy Molly Mulebriar

The best kept secrets of managed care are no longer the industry’s best kept secrets. The cat is out of the bag,

(more…)

Welldyn Sold – Will Super TPA Benefit?

Thursday, August 4th, 2016

mulebriar

“The owner of Welldyn PBM and Continental Benefits has a vision to reduce health care spend in this country by 25%. With fresh capital from the sale of Welldyn, smart money bets Continental Benefits will become a national super TPA in short order. Before the Welldyne sale Continental Benefits was on a fast track. Now it will be nuclearized on an even faster track.” – Molly Mulebriar

(more…)

Narrow Networks = Balance Billing

Thursday, August 4th, 2016

angrydoctor1

Narrow Networks Fueling Surprise Medical Bills and Fights Between Insurers, Providers and Patients

(more…)

Tenet Increases Reserve To Settle Kickback Allegations

Wednesday, August 3rd, 2016

tenetTenet believes it has reached an agreement in principle with the government to resolve the criminal investigation and civil litigation for $514 million.

(more…)

HealthCare’s “Brawl For It All”

Tuesday, August 2nd, 2016

boysfighting

“Woodrow Wilson once said “the seed of revolution is repression”.  Healthcare has operated on a model outside of free market forces, where consumers have paid the price, literally for decades. 

(more…)

BCBS of Texas To Drop 470 Kelsey-Seybold Physicians

Monday, August 1st, 2016

fired

Blue Cross and Blue Shield of Texas will sever ties with Houston-based Kelsey-Seybold Clinic, putting approximately 100,000 patients out of network with the providers’ physicians, the Houston Chronicle reported.

(more…)

Shrinking Networks

Monday, August 1st, 2016

freshberries

Reid Rasmussen

Insurance carriers know it. If you build self-funded plans, you know it. There are ways to reduce plan costs while ‘hiding’ the reduced benefits. One of the rapidly growing methods is to shrink the provider network.

(more…)