“What is an health insurance salesman daddy?”
Month: October 2016
Reference Based Pricing – The Hospital’s Perspective
A 2017 webinar will cover hospital’s view of Reference Based Pricing. An attorney who has advised multiple hospitals on how to respond and interact with self-insured payers taking RBP approaches shares her unique insights on how hospital administrators view common points of contention, as well as opportunities for more collaborative payment arrangements.
Continue reading Reference Based Pricing – The Hospital’s Perspective
HCA Profit Rises 38% in Q3
Revenue has increased 4.2 percent year over year, to $10.3 billion in the third quarter of 2016. Could the ever present annual escalator clause found in managed care contracts be driving revenue increases?
Continue reading HCA Profit Rises 38% in Q3
Bob, Let Us Know When You Run Out of Money
Your decision to continue your current PPO program is understandable. You are not out of money yet.
British Physicians List 40 Procedures Of Little Or No Benefit
Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.
Continue reading British Physicians List 40 Procedures Of Little Or No Benefit
Poor Lisita!
Yikes
Martita, a sixty year old Texan, just received her individual health insurance renewal notice from Blue Cross, the only health insurance company that sells individual health insurance in her area in Texas.
Aetna Exec: People Will Pick Beer Over ObamaCare
People can do the math. Gas for the car, beer on Fridays and Saturdays, or health insurance.
Continue reading Aetna Exec: People Will Pick Beer Over ObamaCare
What If An Employer Cannot Pay Government Fees (Taxes)?
Many employers incorrectly believe there is a chance they can play the “audit lottery” and avoid all ACA related penalties………….
Continue reading What If An Employer Cannot Pay Government Fees (Taxes)?
Healthcare Fraud Investigations Target C-suit
Why Didn’t I Think of This!
The Department of Justice has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.
Continue reading Healthcare Fraud Investigations Target C-suit
The Out-of-Network Battle Heats Up
Payors have begun to take internal steps to avoid the “phantom charges” they claim are being billed by out-of-network providers……………...
Tribal Health Plans Utilize Medicare Rates For Savings
“Tonto, is that your health plan!” ….”Yes, Great White Father finally came through – It’s called Reference Based Pricing!”
Continue reading Tribal Health Plans Utilize Medicare Rates For Savings
Edgewood ISD To Drop Reference Based Pricing Plan
The Edgewood Independent School District in San Antonio, Texas, has decided Cost Plus / Reference Based Pricing is not for them.
Continue reading Edgewood ISD To Drop Reference Based Pricing Plan
City of Lewisville Publishes Health Insurance Analysis – Compares Cost Plus To PPO
The report is a compelling comparative analysis between a PPO proposal and a Cost Plus Insurance proposal, an evaluation of a non-traditional approach to health care financing and a traditional managed care proposal worth reading.
Continue reading City of Lewisville Publishes Health Insurance Analysis – Compares Cost Plus To PPO
340b Rx Program – Discounted Rx For “Poor People” or Profit Center For Hospitals?
The drug industry argues the 340b program has surpassed its original purpose of providing care to poor patients and now acts as a profit generator for hospitals.
Continue reading 340b Rx Program – Discounted Rx For “Poor People” or Profit Center For Hospitals?
Risk of ‘Mass Exodus’ of Doctors from Medicare
One recent survey of physicians found nearly 40 percent expect a “mass exodus” from Medicare……………………..
Continue reading Risk of ‘Mass Exodus’ of Doctors from Medicare
Medicare for All – Being Cost Efficient Gets Incredible Results
Universal health care, Medicare for All, will establish cost efficiency that eliminates major medical bills and medical related bankruptcies
Continue reading Medicare for All – Being Cost Efficient Gets Incredible Results
President Clinton Blasts Obamacare and Pushes for Medicare / Medicaid for All
Benefits Brokers Going the Way of the Dodo Bird – A New Species Emerges
Former Health Insurance Broker
Employees should be outraged and plan sponsors should feel like Madoff has been managing their money — it is time for change and the incumbents are just not getting the job done.
Continue reading Benefits Brokers Going the Way of the Dodo Bird – A New Species Emerges
Texas Insurance Officials Fine Zenefits $550K for Noncompliance
The Texas insurance regulators have fined human resources software startup, Zenefits, $550,000 for its past use of unlicensed health insurance brokers.
Continue reading Texas Insurance Officials Fine Zenefits $550K for Noncompliance
Lucent Health Signs Strategic Alliance with The Phia Group
Lucent is ensuring that the Plan Sponsors they serve will be provided the best fiduciary protection and objective, final appeals handling in the industry.
Continue reading Lucent Health Signs Strategic Alliance with The Phia Group
HST Reference Based Pricing Presentation
Ed Day, President, HST and Cindy Hom, VP of Business Development, MedWatch pride themselves in being ahead of the curve in Reference Based Pricing strategies. The HST approach makes sense. This is a must see 29 minute video:
Introducing Meritain Connect
Introducing Meritain Connect:
Now it’s even easier to stay on top of your health plan management
Meritain Health is proud to announce our new, enhanced website for members, employers, organizations and producers—Meritain Connect. It’s an all-in-one online tool for managing your employee benefits account. And this newly upgraded website will be yours to access beginning Monday, October 17, 2016.
How To Deal With A Bully In Business
Have you ever met a bully in your business dealings? If you say “No” you are probably lying, or too stupid to spot one. A recent experience leads us to post this excellent video on how to deal with a bully
Phia Group’s Quarterly News Letter
Adam Russo, Phia Group
This past quarter has been one of the most exciting in our history, and we have all of you to thank for helping make that happen…………
Dear John, I have Good News & Bad News………….
In order to rebalance our existing and future book of business, we are increasing our HMO new and renewal commission rates, and reducing the commission rates for all new and renewing PPO health plans………..
Continue reading Dear John, I have Good News & Bad News………….
To Drive Real Health Care Reform, Look At What Employers Are Doing
10 percent annual gain in employer health care costs has held wage gains to 2 percent or so in most recent years…….Taking money out of the pockets of consumers is deadly for growth in a consumer-driven economy……
Continue reading To Drive Real Health Care Reform, Look At What Employers Are Doing
UnitedHealth Accused Of Price Gouging
UHC customers paying $50 co-pay for a drug that cost less than $15?
The Truth About The Blues
“When receiving a group medical insurance proposal from the Blues, they can claim to have better discounts than the rest of the competing offers (be it a self-funded or fully insured plan) and their pricing to get the business will surely reflect substantial discounts. But now what? Will you as the client ever actually receive the full value of their hospital contracts or physician discounts? Most likely not.”
Will Public Corruption Probe Expand To “The Valley?”
Court paperwork, however, said the corruption spread further, enabling the Mullen group to land contracts for their clients at South San ISD and Bexar Met. The FBI is also investigating the trio’s activity at school districts in the Rio Grande Valley, the documents show.
Continue reading Will Public Corruption Probe Expand To “The Valley?”
Hospital Must Release Information on Pricing Methodology
This is an interesting case with huge ramifications for Reference Based Plan Sponsors in Indiana and beyond.
Hospital billed patient $625,000. A billing expert has determined the reasonable value of the services Parkview provided was $246,640, about 39 percent of what was charged in the case. Hospital must now disclose pricing methodologies in court…………………..
Continue reading Hospital Must Release Information on Pricing Methodology
Percentage of Doctors Employed By Hospitals Is Up
PHIA To Support “The Big Heist” Project
The Phia Group is pleased to support Dave Chase’s “The Big Heist” project. Dave Chase is a long-time healthcare industry consultant, entrepreneur, author, and provocateur. Mr. Chase is also the executive producer of the upcoming film, “The Big Heist.”
Is It Legal?…………….YES, IT’S LEGAL…NO IT’S NOT!
For years Plan Sponsors have dreamed how to transfer health care risk to the federal government. If Medicare eligible plan participants could be removed from a group’s health care plan legally, these higher risk members would no longer be a risk factor to contend with. How can one game the system? Continue reading Is It Legal?…………….YES, IT’S LEGAL…NO IT’S NOT!
Tenet Hospitals To Pay $513M, Admit Kickbacks
Tenet Healthcare Corp. and two of its hospitals will pay $513 million and enter guilty pleas to resolve investigations into payments of kickbacks for referrals of pregnant immigrants, the U.S. Department of Justice said Monday.
Continue reading Tenet Hospitals To Pay $513M, Admit Kickbacks