Archive for February, 2017

THE TRUTH (as we see it) About the Blues PPO Discounts

Saturday, February 25th, 2017

truthThis article is not being written because we won’t do business with the Blues or because we see them as the only carrier with faults. However, over the years we’ve gotten tired of hearing the misconceptions and deceptions about what is being offered and how and why they are able to make some of the offers that they do.

(more…)

Health Insurance Consultants Beware!

Friday, February 24th, 2017

witness

Insurance Consultant On Hot Seat

By Bill Rusteberg

Plan sponsors are taking their fiduciary responsibilities more seriously these days. Anxious attorneys have found a new and lucrative venue.

(more…)

This is Outrageous!

Thursday, February 23rd, 2017
mulebriarA few minutes ago I reviewed a 440 facility claim run on a school district. This information is not the type of information a plan sponsor will ever get from a BUCA. And, you will not find many TPA’s providing this information either.

(more…)

Spineless Republicans To Disregard Voters?

Thursday, February 23rd, 2017

spineless

First the republicans wanted the House to influence change. They got the House and did nothing. Then they wanted the Senate to influence change. They got the Senate and did nothing. Then they wanted the Presidency to influence change. They got that too and they continue to do nothing.

Do you trust Republican politicians any more? 

(more…)

Dark Horse Captures DART Account

Thursday, February 23rd, 2017

darkhorseThe Dallas Area Rapid Transit (DART) has spend the better part of a year or more evaluating their employee health & welfare plan. Health care costs have placed increasing budgetary pressure on DART’s operating expenses. Management knew something had to change to continue offering benefits. There had to be a better way to offer health care benefits and tame the health trend dragon.

(more…)

Has Texas Lost It’s Cajones?

Monday, February 20th, 2017

cojonassClueless politicians in Austin are in dire need of good advice from others than managed care providers, insurance carriers and medical caregivers who all have vested interests in continuing the status quo. Time is running out for common sense to have a place at the table this legislative session. 

(more…)

Super TPAs to the Rescue

Sunday, February 19th, 2017

 

 

He spent 20 years at Aetna, building and leading teams that sold health coverage to the largest employers in the U.S. Then transformation happened, and his heart led him to start a new type of TPA to do it better. Today – Jeff Bernhard, President of Super TPA Continental Benefits.

(more…)

A State-by-State Breakdown Of Hospital Adjusted Expenses Per Inpatient Day

Sunday, February 19th, 2017

childraisinghand

Would an old fashion indemnity plan work just as well as a convoluted PPO plan tied to egregious contracts of adhesion, i.e., managed care?…………………

(more…)

These 28 Hospitals Have The Worst Organ Transplant Outcomes

Sunday, February 19th, 2017

worstdoctor

Written by Heather Punke (Twitter | Google+)  | February 10, 2017

Whether or not a patient’s transplant is successful could boil down to hospital choice, as some hospitals have much worse outcomes than others, according to data from the Scientific Registry of Transplant Recipients.

(more…)

Texas School Trustee Arrested In Insurance Bribery, Kickback Scheme

Thursday, February 16th, 2017

saisd

Hernandez, 66, is accused of accepting cash, jewelry, and travel from people working for a school district insurance carrier and a paid independent insurance consultant for her influence on the district’s board of trustees and her vote on numerous insurance services contracts awarded to the companies with whom the co-conspirators had a financial interest.

(more…)

Paying Cash For Health Care

Thursday, February 16th, 2017

horsebuggy

As one observer put it, in describing our current claim process “a horse-and-buggy in a world contemplating driver-less cars, the healthcare industry’s consumer billing and payment system is an inefficient antique.”

(more…)

Edinburg ISD Seeks Insurance Consultant

Thursday, February 16th, 2017

Edinburg Independent School District, located in deep South Texas, is seeking a fee based insurance consultant to provide assessment, advice and guidance in the management of the district’s self-funded employee health & welfare program.

(more…)

Tuesday, February 14th, 2017

riskmanagers.logo

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

2014 RiskManagers.us All Rights Reserved

 

Employer Solves High Cost of Specialty Drugs

Tuesday, February 14th, 2017

potofgold

By Bill Rusteberg

A 400 employee life group in Texas, like many other employers across the United States, was experiencing high drug costs running into hundreds of thousands of dollars per year primarily due to specialty drugs. This self-funded plan had to do something to stop out of control prescription drug costs.

(more…)

Is Your Consultant/Broker Receiving Undisclosed Compensation?

Monday, February 13th, 2017

mulebriar

“In some cases, brokers can be paid undisclosed compensation, based on the size of their book of business with a carrier. ….. Many carriers also offer bonuses called “contingency” or “persistency” payments, where a broker is paid for keeping business in place, or providing “new placements.” According to an industry studies of benefits brokers, on average, 4-12% of a broker’s annual revenue  is derived from these undisclosed payments.”

(more…)

Will Texas Provide TRS ActiveCare Claim Experience Should Districts Be Forced Out?

Monday, February 13th, 2017

buzzardTexas school  districts of 1,000 employees and more may be forced out of TRS-ActiveCare and left to find their own alternative health care plans for employees. How are these districts going to find competitive bids without detailed claim experience? Will Aetna have market advantage? Will selected Aetna insurance agents/brokers have market advantage too? Will the state release claim information to each affected district?  Has marketing already begun, with agents circling the TRS ActiveCare carcass with the promise of “a safe harbor?” 

(more…)

Kidney Heists, Alligators & PPO Networks

Friday, February 10th, 2017

dendy

Mike Dendy

“The myth of PPO “discounts’ has been circulating for about 20 years now.  Blind belief in the myth costs employers and their employees millions of dollars on their health plans every year. “

(more…)

Sagebrush

Wednesday, February 8th, 2017

sage

ARE YOU LEAVING MONEY OUT THERE?

Recovering losses and preventing leakage in your claims-payments pipeline are your first steps to a better bottom line. Even responsible healthcare payers lose revenue due to overpayments (upwards of 7.0 %*).

(more…)

Hide and Go Seek

Wednesday, February 8th, 2017

hideseekIf your company was a self-funded customer of BCBSM at any time since 1994, it is very likely that you also have a hidden access fee claim……………Even small companies can have hidden fee claims worth hundreds of thousands of dollars.

(more…)

Cars, Hotel Rooms & PPO’s

Sunday, February 5th, 2017

hotelroom 

Room Cost Reduced 60%! Now Only $40,000

“If you think PPO programs save you money, rethink and ask yourself, compared to what? The average national PPO pays hospitals over 250% of Medicare. It will get worse next year and the year after when annual PPO-Hospital escalator clauses go into effect. PPO’s are a contract to overpay for healthcare services!”

(more…)

Undercover Work Exposes Bonus Arrangement For Insurance Consultants

Saturday, February 4th, 2017

mulebriar

“Yes, and it’s beautiful! The client does not have a clue about this. It will not show up on the 5500 Form either! It simply is not disclosed at all to the client.”

(more…)

RiskManagers.us Opens 4 New Offices

Thursday, February 2nd, 2017

This is the future office.

“Why would you invest in so much expensive real-estate for your employees? The Future office is already getting into the backyard of the new economy employees and companies. It is about results and not about presence and losing many many hours by traveling to your main office” – Unknown Author

(more…)

Why Healthcare Costs Are So High & Why Fixes Are So Difficult

Wednesday, February 1st, 2017

confused“One consultant relayed how he had reviewed claims data and found self-insured employers are paying up to 250 percent of what Medicare pays for the same service. By direct contracting he has helped his clients get rates of 150 percent of Medicare’s price.”

(more…)