Archive for March, 2017

Thoughts on “Repeal and Replace”…

Sunday, March 26th, 2017

mess

I am not the first to say this, but I am disappointed that given the opportunity to replace the “access” program represented by ACA/Obamacare with real reform, our friends in Washington have “punted” again! I guess the financial and other benefits provided by the American Hospital Association, American Medical Association and Blue Cross and Blue Shield Association ultimately outweigh doing the right thing.  

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“It’s Been A Great Week!”

Sunday, March 26th, 2017

obamal

“In power or not, we Rule!……..Have a nice day!”

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Allied National Has Answers For Consumers on Reference Based Pricing

Friday, March 24th, 2017

allied

“Our experience is that virtually all providers will accept these Medicare “plus” reimbursement levels.”

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Patient Concerned About Black Testicles

Friday, March 24th, 2017
balls
“There’s nothing wrong with them, Sir. They look magnificent.” 

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Ransom Insurance vs Dental Insurance

Friday, March 24th, 2017

petersen1A Rio Grande Valley woman said she’s not going back to a dentist in Mexico. She claimed she wasn’t allowed to leave the office.

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What Can US Policymakers Learn About Essential Health Benefits From Israel?

Thursday, March 23rd, 2017

israel

It may surprise readers to know that Israel has a system very much in line with many US policymakers’ goals of fostering a competitive private insurance market. The Israeli system rests on the concept of competing private health plans selling care in a market of empowered consumers. But one crucial difference is how Israel approaches the question of what it means to be covered.

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What Does Bernie & The Donald Have In Common?

Wednesday, March 22nd, 2017

bernietrump

Trump has promised that “ (Rx) pricing for the American people will come way down.”

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Reduce Total Health Benefits Spend By 20-40%

Wednesday, March 22nd, 2017

riskmanagers.logoLearn how moving to self-insurance managed by a fully independent Third Party Administrator (TPA) linked to high value providers and services can reduce your total benefits spend by 20 to 40%.

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ObamaCare Is 60% Welfare

Wednesday, March 22nd, 2017

handout

ObamaCare Is 60% Welfare – Lunch Alert!

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12 Years Later…… Do Undisclosed, Secret, Back Door Agreements Still Exist?

Tuesday, March 21st, 2017

mulebriar

Do insurance agents, brokers and consultants still receive undisclosed compensation from the vendors they recommend? 

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The Tale of Two Waiting Rooms

Sunday, March 19th, 2017

whores

Like the old whore houses of the Wild West, patients at the Mayo Clinic may be directed to one of two waiting rooms. In the good ole days, upon entering the local cat house one was directed to one of two waiting rooms. The room on the left was for “second rate citizens” and the room to the right was saved for “1st class citizens” such as lawyers, doctors, and the wealthy.

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Average Reimbursement Rates For Hospitals Exposed

Saturday, March 18th, 2017

screwedaaIf you are not getting 70-80% off billed charges you are getting screwed……………..This article proves the fallacy of hospital charge master rates which no one ever, ever pays……………

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Weslaco ISD – THE FIRST Texas School District To Seek Competitive RBP Proposals

Thursday, March 16th, 2017

weslacoUnder the leadership of the district’s risk manager, Mike De La Rosa, the Weslaco Independent School District has historically demonstrated an almost unequaled track record of  “thinking outside the box” amongst Texas school districts.

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Thoughts From The TPA Front Lines

Wednesday, March 15th, 2017

mcs

Things are moving at light speed for TPAs, with new technology, approaches to disrupting traditional use of PPOs, carriers seeing TPAs as sources of business, increasing interest in participant engagement and widespread investor interest.

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Broker Asks RiskManagers.us Opinion on Direct Contract Offer

Wednesday, March 15th, 2017

mad

The game is over. Plan sponsors are becoming more educated. The secret ingredients of managed care contracts are now known to many. And they are mad as hell and not going to take it anymore.

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AssuredPartners Acquires Keenan

Wednesday, March 15th, 2017

keenanAcquisitive insurance brokerage AssuredPartners Inc. is making a significant move into California with the purchase of Keenan & Associates in a deal that will push AssuredPartners’ annual revenue over $800 million.

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Invitation to Join Broker and Benefit Executives

Monday, March 13th, 2017

whealthcongressWith the acknowledgment that many benefits consultants drive decisions that are at odds with optimal health plan performance, benefits managers and brokers are increasingly advocating for consulting practice principles that align more directly with purchasers interests.

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Where’s The Beef?

Sunday, March 12th, 2017

beef

“No one is entitled to health insurance. No one is entitled to health care. And just as certainly no one is entitled to a $1 million bank account or one with unlimited funds. So where’s the beef?” – Molly Mulebriar

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MediBid Enhances its Free Market Medical Pricing for Self-Funded Employers

Sunday, March 12th, 2017

medibid

“This groundbreaking innovation in medical price transparency will further disrupt the insurance company dominated status quo and give patients increased leverage in obtaining the best value for their health care dollar,” says MediBid CEO Ralph Weber.

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A New Reference Based Pricing Self-Funded Plan Design Available Soon!

Friday, March 10th, 2017

Starmark Healthy Choicesâ„  – Available Soon

Starmark

AtlasMD Touts Allied National

Thursday, March 9th, 2017

allied

He founded the Wichita direct-care medical practice more than six years ago ……. He cited Allied National Inc. in Overland Park as an example of an insurance company whose profit margins have increased by incorporating the Atlas model………….

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Republicans Lay Waste To Their Base On Health Reform

Wednesday, March 8th, 2017

sherman

William Tecumseh Sherman, who laid waste to the South at the end of the Civil War, famously said, “War is Hell”.  So, too, is health reform.

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The Difference Between A BUCA and an Independent TPA Can Be Stark

Wednesday, March 8th, 2017

stark

A recent request from one of our clients to their record keeper was simple; What have we been paying, on average, for certain procedures? The response/s in a string of emails lays out a simple request into one of enormous complexity, seasoned with a good dose of Bull S–T.

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2007 Leap Into Uncharted Waters Saves Clients Millions

Tuesday, March 7th, 2017

riskmanagers.logo“It has been seven years since our first client exited the managed care world. Subsequently more clients have embarked on the same journey, most with equally good results. None have returned to the world of managed care” – 

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Escalator Clauses, Rising Prices, And Why We Should Care

Tuesday, March 7th, 2017

escalatorYou may have asked yourself why health prices rise inexorably. Are escalator clauses, the automatic price increases common to many managed care contracts, the driving force behind trend factors?

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Responding to Non-Network Plans Using Reference-Based Pricing

Tuesday, March 7th, 2017

rope

Father of The Rope-A-Dope Method of Winning – Mohammed Ali

Attorney advises hospitals how to respond to Reference Based Pricing Plans…………..a revival of the Rope-A-Dope?

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The Coming Implosion of TRS ActiveCare?

Monday, March 6th, 2017

angryteacher

TRS-Care 1, 2 and 3 will go away………….There will be only one plan: a high deductible health care plan…….Premiums would be an estimated $430 per month, or $5,160 per year!…..The deductible of $4,000 would need to be met before plan coinsurance starts……There would be 80/20 coverage after meeting the $4,000 deductible…….The maximum annual out-of-pocket (MOOP) limit will be $7,150……There would be no prescription copays. All prescription coverage is part of deductible requirements…

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Why Benefits Advisors With A Future Are Developing More Transparent Arrangements

Monday, March 6th, 2017

klepper

Currently, many benefits consultants drive decisions that are at odds with optimal health plan performance. Organizational purchasers, benefits managers and brokers are increasingly advocating for consulting practice principles that align more directly with purchasers interests.

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TRS Healthcare Bill Offers Fewer Options, No Savings

Monday, March 6th, 2017

Man shouting, pulling hair

If passed, SB 789 would limit districts that may participate in TRS-ActiveCare to those with 1,000 or fewer employees. The bill would eliminate the traditional co-payment insurance plan option, leaving only one plan (high-deductible, no copays) Districts with fewer than 1,000 employees will be given a one-time opportunity to opt out of TRS-ActiveCare.

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Free Market Solution To Rising Health Care Costs

Sunday, March 5th, 2017

mulebriar

“The only difference between Republicans and  Democrats is Republicans take a little longer to get there” – Molly Mulebriar

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Tx. School District Feeding Frenzy Begins…………………

Thursday, March 2nd, 2017

feedingfrenzy

Insurance agents, sensing an opportunity of a lifetime, are lining up to feed on the TRS ActiveCare scraps.

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