Archive for September, 2016

Consultant Sentencing Delayed Again – Now 30 November 2016

Friday, September 30th, 2016

haff

William O. Haff

San Antonio insurance consultant’s sentencing delayed again to 30 November, 2016. Smart money bets more indictments to come, following this week’s indictment of Samuel Mullen……

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A Golden Ticket That Fast-Tracks A Drug Through The FDA

Friday, September 30th, 2016

wonkaDrugmaker Sarepta Therapeutics won a big victory when its $300,000 muscular dystrophy drug was recently approved, but the company had other reasons to celebrate, too. They were also awarded the drug world’s equivalent of a Willy Wonka golden ticket.

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Is Expanding Medicaid a Good Idea for Texas?

Friday, September 30th, 2016

money11111“I offer three perspectives as to why Texas should not expand Medicaid” – Alan M. Preston, MHA, Sc.D.

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Rigged Insurance Contracts Bring Indictments / Guilty Pleas

Tuesday, September 27th, 2016

mullen1

In total, prosecutor Mark Roomberg said, the commissions resulting from the rigged contracts were “$2.5 million for the entire group.”

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Are PPO’s Saving Money, Or Costing Employers More?

Tuesday, September 27th, 2016

mulebriar

A Medical Bill Review audit of a large, 4,500 life employer group performed in 2016 exposes the truth about PPO “discounts.”

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Over 100 CIGNA Administered Plans Sued For Embezzlement

Monday, September 26th, 2016

flores

By Mark Flores

Just eight days after a federal court slammed CIGNA with a $13M judgement, 113 of CIGNA’s self-insured clients, along with their Plan Administrators have been named as defendants in a massive fraud lawsuit, alleging the plans “participated in a conspiracy and pattern of unlawful, reckless, and deceptive conduct to conceal an embezzlement and/or skimming scheme”.

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More Proof Reference Based Pricing Is Growing Market Share

Sunday, September 25th, 2016

lemons

The following article illustrates the angst hospitals are undergoing in defending their indefensible and egregious pricing strategies through their PPO collaborators. The solution posed in this article by a hospital advocate is: Identify Reference Based Pricing (RBP) patients and don’t treat them! But that short sighted response brings on Cash Pricing strategies through companies like Asserta Health (www.assertahealth.com) which often times saves plan sponsors even more money than otherwise would have been paid hospitals under a typical RBP plan. Making lemonade out of lemons……………

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Insurance Consultant To Be Sentenced Wednesday, 28 September?

Saturday, September 24th, 2016

haff

 

A 46-year-old San Antonio independent insurance consultant William O. Haff is facing up to five years in federal prison…. 

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California’s Health Care is 70% Socialized

Friday, September 23rd, 2016

california

This year, taxpayers will cover about 70 percent of what is spent on health care in California, according to a new analysis released Wednesday by the UCLA Center for Health Policy Research.

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TransparentRx – Elimination of Hidden Costs

Friday, September 23rd, 2016

 transparentrx

Most TPAs do not pass on the strong discounts for prescription drugs or do not have access to it. A quality TPA should be offering all prescription drugs at AAC + admin fee.

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Proceeding With Caution On Worksite Clinics

Tuesday, September 20th, 2016

pig“You can claim — and many do — that better access provides worthwhile value, but that’s akin to putting lipstick on a pig.” – Brian Klepper

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Illinois Extents Hep. C Treatment for Medicaid Recipients

Tuesday, September 20th, 2016

healthsity

If Medicaid allowed overseas treatment for Hep. C (Harvoni) the savings by utilizing a five star hospital system 495 miles south of Florida would save taxpayers 753 X ($95,000 – $19,000) = +$57 million...

For Information on Health City, contact Sarah Rusk, Health City Cayman Islands
t 345-640-4257  m 345-525-2131  healthcity.ky

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Which Physicians Generate The Most Money for Hospitals?

Tuesday, September 20th, 2016

doctor2

Primary care physicians presented the best return on investment for hospitals

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Apex Management Group Announces 4 Year Rate Guarantee

Friday, September 16th, 2016

apex

FOR IMMEDIATE RELEASE – September 2016
Apex Management Group (Oak Brook, Illinois) has announced a 4 Year Rate Lock on their APEX Suite of MEC Offerings. 

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Grand Theft Health Insurance

Thursday, September 15th, 2016

theft

It is the Obama administration, and not the insurers, who perpetrated this heist….

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Would You Like Some Insurance With Your Insurance?

Thursday, September 15th, 2016

gap1“After I got off the phone with him, I realized: That’s actually just insurance for my insurance,” she said, laughing.

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2016 Directory of Third-Party Administrators

Tuesday, September 13th, 2016

tpa12

See our detailed directory listing of TPAs, which includes their 2015 revenue, claims business by type and by volume, types of client managed and other contact information.

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Cost Plus Health Plan Guarantees No Balance Billing

Tuesday, September 13th, 2016

alliednationball“We guarantee no “balance bills” to our covered members for the amount taken as a discount from your provider’s retail bill.”

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Will England Eliminate 7 Day Health Care – Don’t Get Sick On Weekends?

Monday, September 12th, 2016

nhs

“16% more likely to die if they are admitted on a Sunday compared with a Wednesday” SOLUTION: Eliminate all health care services on Sunday…………..

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Healora – Cash Pay Health Plans Make Sense

Saturday, September 10th, 2016

healora

Imagine being in control of your individual employee healthcare costs. Our low cost network puts you in control of your daily healthcare spend. You decide whether the employee is better off using existing insurance options or pre-paying for the specific procedure. Our pre-paid pricing is based on discounts of up to 70% and can save companies millions of dollars a year.

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Super TPA Purchases Maxor Administrative Services

Friday, September 9th, 2016

mulebriar

Texas Super TPA with growing market share is a  TPA worth watching…….

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Study: Chargemasters still drive up revenue at US hospitals

Thursday, September 8th, 2016

lustig Victor Lustig

Just like sticker prices on new cars, no one ever pays hospital chargemaster rates. So why have them? A previous blog posting (Hospitals Dismiss Significance Of Chargemaster Prices?offers a possible reason, while the following article does too.

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Senator Addresses EpiPen Scandal

Thursday, September 8th, 2016

confusedA pack of just two EpiPens costs more than $600 in the United States. To fully comprehend the outrage of this price, you must realize that the epinephrine included in the EpiPen costs less than $10 retail. And in Mexico it’s 25 cents (EpiPen alternative costs pennies in Mexico)

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How Employers Can Avoid Outrageous Health Care Overcharges

Wednesday, September 7th, 2016

life

Employers, adept at tracking business expenses, are surprisingly lax when it comes to double-checking healthcare costs.

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Farnsley Responds To Forbes Article

Tuesday, September 6th, 2016

farnsley John Farnsley

“We learn from history that we do not learn from history” – George Hegel

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Have PPO Networks Perpetrated The Greatest Heist In American History?

Monday, September 5th, 2016

heistUnderstanding the cost of health care is directly related to what we agree to pay, more and more employers are questioning managed care contracts upon which their health care costs are based. Many are discovering the truth for the first time.”

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EpiPen alternative costs pennies in Mexico

Sunday, September 4th, 2016

outrageous

McALLEN — A life-saving medication that costs more than $600 in the United States is only a few cents in Mexico.

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California Passes Balance Billing Protection Legislation

Friday, September 2nd, 2016

surpriseCalifornia medical consumers will enjoy strong new protection against surprise out-of-network medical bills..………..

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Narrow Networks Growing More Common

Thursday, September 1st, 2016

narrownetworksHealth insurers are limiting the physician and hospital options they offer through their plans. TRANSLATION: Insurers are limiting provider choice by eliminating providers who want more money than those willing to work for less.

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California Senate Approves Reference Based Pricing

Thursday, September 1st, 2016

ben

“The bill would relieve patients from having to pay surprise medical bills out of pocket by requiring insurers to reimburse out-of-network doctors and other health providers a “fair amount” and doctors to accept the payments, said its author, Assemblyman Rob Bonta (D-Oakland).”

“That rate would be 125 percent of the amount Medicare pays for the same service or the insurer’s average contracted rate for the service, whichever is greater.”

Editor’s Note: If California passes this bill into law (very likely), Reference Based Pricing in California will take off in the private sector. No network plans, similar to what we have implemented in Texas since 2007, will have solved the problem of balance billing risk. And if Texas passes a similar law TPA’s like Caprock Health Plans and Continental Benefits, both of which administer Reference Based Pricing plans will achieve new business sales that will make Ben Feldman look like an amateur.

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